Healthcare Provider Details

I. General information

NPI: 1285458422
Provider Name (Legal Business Name): MICHELLE CAPALBO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 FENROSE CIR
MELBOURNE FL
32940-1256
US

IV. Provider business mailing address

4224 FENROSE CIR
MELBOURNE FL
32940-1256
US

V. Phone/Fax

Practice location:
  • Phone: 321-432-3998
  • Fax:
Mailing address:
  • Phone: 321-432-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT9766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: