Provider Demographics
NPI:1568533834
Name:CAPONE, BRANDT (PT)
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:
Last Name:CAPONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2930
Mailing Address - Country:US
Mailing Address - Phone:603-591-4932
Mailing Address - Fax:
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:STE 203
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-889-0177
Practice Address - Fax:603-889-0176
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25262251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports