Provider Demographics
NPI:1023492311
Name:CAPETILLO, LORRIE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:CAPETILLO
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 CASTLE BAY DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6680
Mailing Address - Country:US
Mailing Address - Phone:281-831-0614
Mailing Address - Fax:
Practice Address - Street 1:2228 CASTLE BAY DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6680
Practice Address - Country:US
Practice Address - Phone:281-831-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer