=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376946202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT MICHAEL CAPODANNO PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 935 WASHINGTON ST
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-255-5999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 PRATT ST UNIT 1
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02048-1927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-254-5456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 8876
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------