Provider Demographics
NPI:1881337855
Name:DEPOSITAR, STEPHANIE JO CAPALLA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:STEPHANIE JO
Middle Name:CAPALLA
Last Name:DEPOSITAR
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122A HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2414
Mailing Address - Country:US
Mailing Address - Phone:540-817-5297
Mailing Address - Fax:
Practice Address - Street 1:160 KENDAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-1786
Practice Address - Country:US
Practice Address - Phone:540-463-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist