Provider Demographics
NPI:1780907758
Name:KAPPEN, SALLY (MPT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:KAPPEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2685
Mailing Address - Country:US
Mailing Address - Phone:937-470-7612
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4124
Practice Address - Country:US
Practice Address - Phone:203-431-7632
Practice Address - Fax:203-431-9259
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016659225100000X
MN7062225100000X
FLPT23184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1114979226OtherANTHEM BLUE CROSS