MEDICARE: MR. JOSEPH PAUL CAPPELLERI P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6952	MN
2	225100000X	Physical Therapist	2305204551	VA
3	225100000X	Physical Therapist	2753	HI

General Provider Information

NPI Number	:	1306042916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PAUL CAPPELLERI P.T.

Provider Business Mailing Address
First Line	:	2665 15TH AVE E
Second Line	:
City	:	NORTH SAINT PAUL
State	:	MN
Zip	:	55109-2329
Country	:	US
Telephone Number	:	612-964-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	2665 15TH AVE E
Second Line	:
City	:	NORTH SAINT PAUL
State	:	MN
Zip	:	55109-2329
Country	:	US
Telephone Number	:	612-964-9561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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