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General NPI Number Information
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NPI Number | 1104701135
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Entity Type | Individual
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Provider Name | JETHRO ANGELO CAPATI
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Gender | Male
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 1902 JAMES L REDMAN PKWY
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City | PLANT CITY
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State | FL
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Zip | 33563-7101
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Country | US
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Telephone | 813-652-8027
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 BROWN NODDY LN
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City | TAMPA
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State | FL
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Zip | 33619-4316
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Country | US
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Telephone | 813-869-1294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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