Healthcare Provider Details

I. General information

NPI: 1124640156
Provider Name (Legal Business Name): TROY MICHAEL CAPPOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 DOUGLAS PIKE
SMITHFIELD RI
02917-1291
US

IV. Provider business mailing address

8 HIGHLAND ST
PEABODY MA
01960-1917
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-3000
  • Fax:
Mailing address:
  • Phone: 978-807-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: