Provider Demographics
NPI:1205910817
Name:CAPPER, CAROL ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:CAPPER
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 1:1054 S DE ANZA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3553
Mailing Address - Country:US
Mailing Address - Phone:408-873-8188
Mailing Address - Fax:408-873-8138
Practice Address - Street 1:1054 S DE ANZA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3553
Practice Address - Country:US
Practice Address - Phone:408-873-8188
Practice Address - Fax:408-873-8138
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT24377Medicare ID - Type UnspecifiedMEDICARE