Provider Demographics
NPI:1023786423
Name:CAPELO, COLLEEN JOY (PTA)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOY
Last Name:CAPELO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4623
Mailing Address - Country:US
Mailing Address - Phone:401-215-6119
Mailing Address - Fax:
Practice Address - Street 1:225 WHITE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6351
Practice Address - Country:US
Practice Address - Phone:910-353-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00423225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant