Provider Demographics
NPI:1659425692
Name:CAPPS, LARA (PTA, MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:CAPPS
Suffix:
Gender:F
Credentials:PTA, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VES RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-4638
Mailing Address - Country:US
Mailing Address - Phone:434-386-3483
Mailing Address - Fax:
Practice Address - Street 1:501 VES RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-4638
Practice Address - Country:US
Practice Address - Phone:434-386-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605791225200000X
VA2255A2300X
TN9382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant