Provider Demographics
NPI:1952638363
Name:CAPOBIANCO, NINA (LMT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 IDEAL RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1452
Mailing Address - Country:US
Mailing Address - Phone:508-241-2110
Mailing Address - Fax:508-319-3200
Practice Address - Street 1:76 OTIS ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3315
Practice Address - Country:US
Practice Address - Phone:508-241-2110
Practice Address - Fax:508-319-3200
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA93172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225700000XOtherMASSAGE THERAPIST