Provider Demographics
NPI:1649288648
Name:CAPITOL PHYSICAL THERAPY CENTER INC
Entity type:Organization
Organization Name:CAPITOL PHYSICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSA
Authorized Official - Middle Name:KOREEN
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:916-446-1497
Mailing Address - Street 1:2288 AUBURN BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1619
Mailing Address - Country:US
Mailing Address - Phone:916-446-1497
Mailing Address - Fax:916-446-5959
Practice Address - Street 1:2288 AUBURN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1619
Practice Address - Country:US
Practice Address - Phone:916-446-1497
Practice Address - Fax:916-446-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ46010ZOtherBLUE SHIELD
ZZZ17574ZMedicare ID - Type Unspecified