Provider Demographics
NPI:1942750476
Name:CAPATA, KEVIN RICHARD (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICHARD
Last Name:CAPATA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4870 BARRANCA PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1701
Mailing Address - Country:US
Mailing Address - Phone:949-653-7878
Mailing Address - Fax:949-653-7848
Practice Address - Street 1:4870 BARRANCA PKWY STE 340
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1701
Practice Address - Country:US
Practice Address - Phone:949-653-7878
Practice Address - Fax:949-653-7848
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist