Provider Demographics
NPI:1891913729
Name:CAPUANO, PHYLLIS JANE (MOTR-L)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:JANE
Last Name:CAPUANO
Suffix:
Gender:F
Credentials:MOTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 N 22ND WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7801
Mailing Address - Country:US
Mailing Address - Phone:602-954-4564
Mailing Address - Fax:480-773-7874
Practice Address - Street 1:6045 W CHANDLER BLVD
Practice Address - Street 2:SUITE 13, PMB 101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3440
Practice Address - Country:US
Practice Address - Phone:480-200-2937
Practice Address - Fax:480-773-7874
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770512OtherACCHS NUMBER