Healthcare Provider Details

I. General information

NPI: 1033174438
Provider Name (Legal Business Name): KRISTEN N. CAPERNA PT, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 GREENSPRING AVE STE 301
BALTIMORE MD
21209-4358
US

IV. Provider business mailing address

2112 ABBOTT WAY
WOODSTOCK MD
21163-1440
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-7790
  • Fax: 410-601-1470
Mailing address:
  • Phone: 410-203-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004512
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: