Provider Demographics
NPI:1710984257
Name:CAPUTO, KATHLEEN SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUZANNE
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SUZANNE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:822 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3359
Mailing Address - Country:US
Mailing Address - Phone:330-758-8223
Mailing Address - Fax:
Practice Address - Street 1:822 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3359
Practice Address - Country:US
Practice Address - Phone:330-758-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ38411Medicare UPIN
OH4153431Medicare ID - Type Unspecified