Provider Demographics
NPI:1356611107
Name:CAPULONG, CARLO MIKHAIL LOCSIN (PT)
Entity type:Individual
Prefix:MR
First Name:CARLO MIKHAIL
Middle Name:LOCSIN
Last Name:CAPULONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 NATHAN HALE DR
Mailing Address - Street 2:APARTMENT 201
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4984
Mailing Address - Country:US
Mailing Address - Phone:240-479-0774
Mailing Address - Fax:
Practice Address - Street 1:4706 NATHAN HALE DR
Practice Address - Street 2:APARTMENT 201
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-4984
Practice Address - Country:US
Practice Address - Phone:240-479-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01894300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist