Provider Demographics
NPI:1922883024
Name:CAPULONG, AERIELLE NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:AERIELLE NICOLE
Middle Name:
Last Name:CAPULONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11049 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3933
Mailing Address - Country:US
Mailing Address - Phone:929-669-4490
Mailing Address - Fax:
Practice Address - Street 1:11049 70TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3933
Practice Address - Country:US
Practice Address - Phone:929-669-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist