Provider Demographics
NPI:1326024225
Name:CAPOGNA, CHRISTOPHER STEPHEN (MPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEPHEN
Last Name:CAPOGNA
Suffix:
Gender:M
Credentials:MPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
Practice Address - Street 1:330 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3861
Practice Address - Country:US
Practice Address - Phone:203-538-0021
Practice Address - Fax:203-466-8527
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1326024225Medicaid