MEDICARE: MRS. JODI CAP

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	1439	SD

General Provider Information

NPI Number	:	1972752459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODI CAP

Provider Business Mailing Address
First Line	:	1319 W HAVENS AVE
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-4116
Country	:	US
Telephone Number	:	605-996-4778
Fax Number	:	605-996-3660

Provider Business Practice Location Address
First Line	:	1319 W HAVENS AVE
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-4116
Country	:	US
Telephone Number	:	605-996-4778
Fax Number	:	605-996-3660

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

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	10/13/2010

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Directions to “ MRS. JODI CAP ” Practice Location

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