Provider Demographics
| NPI: | 1568538064 |
|---|---|
| Name: | CAPUCHINO THERAPY GROUP |
| Entity Type: | Organization |
| Organization Name: | CAPUCHINO THERAPY GROUP |
| Other - Org Name: | ISIS HEALTHCARE SERVICES INC. |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | LULA |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | CAPUCHINO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OTR/L |
| Authorized Official - Phone: | 916-481-1300 |
| Mailing Address - Street 1: | 1015 RILEY STREET |
| Mailing Address - Street 2: | #6268 |
| Mailing Address - City: | FOLSOM |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 95630-6268 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 916-481-1300 |
| Mailing Address - Fax: | 916-365-9870 |
| Practice Address - Street 1: | 3601 MARCONI AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | SACRAMENTO |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 95821-5309 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 916-481-1300 |
| Practice Address - Fax: | 916-365-9870 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-11-27 |
| Last Update Date: | 2024-01-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | OT2084 | 225000000X, 225XF0002X, 225XH1200X, 225XP0200X, 225XR0403X |
| CA | PT23114 | 2251E1200X |
| CA | PT40045 | 2251X0800X |
| CA | 2084 | 225X00000X |
| CA | SP6954 | 235Z00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | 616046300 | Other | DEPT OF LABOR |
| CA | ZZZ53443Y | Other | BLUE SHIELD - PT |
| CA | ZZZ72016Y | Other | BLUE SHIELD - SP |
| CA | ZZZ67977Z | Other | BLUE SHIELD - OT |
| CA | BA402 | Medicare PIN |
