Provider Demographics
NPI:1861462152
Name:CAPSTONE HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:CAPSTONE HEALTH SERVICES INC.
Other - Org Name:CAPSTONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-255-7876
Mailing Address - Street 1:8862 BENDER ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-8800
Mailing Address - Country:US
Mailing Address - Phone:360-354-1115
Mailing Address - Fax:360-354-0321
Practice Address - Street 1:1887 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9426
Practice Address - Country:US
Practice Address - Phone:360-384-5111
Practice Address - Fax:360-384-0006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE HEALTH SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11742266225100000X
225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089477Medicaid
WA7089477Medicaid
WAGAB07442Medicare PIN