MEDICARE: KATHLEEN SUZANNE CAPUTO P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT010856	OH

General Provider Information

NPI Number	:	1710984257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SUZANNE CAPUTO P.T.

Provider Business Mailing Address
First Line	:	822 E WESTERN RESERVE RD
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-3359
Country	:	US
Telephone Number	:	330-758-8223
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 E WESTERN RESERVE RD
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-3359
Country	:	US
Telephone Number	:	330-758-8223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/28/2010

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