Provider Demographics
NPI:1760024509
Name:CAPERS, ETHAN HEDGES (PT)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:HEDGES
Last Name:CAPERS
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:PO BOX 860550
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0505
Mailing Address - Country:US
Mailing Address - Phone:952-924-0199
Mailing Address - Fax:952-924-0314
Practice Address - Street 1:755 PRIOR AVE N STE 235E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1063
Practice Address - Country:US
Practice Address - Phone:651-645-8083
Practice Address - Fax:651-645-8078
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist