MEDICARE: KIM CAPENA

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	042956	NY

General Provider Information

NPI Number	:	1679057061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM CAPENA

Provider Business Mailing Address
First Line	:	25C CARTER ST
Second Line	:
City	:	DANIELSON
State	:	CT
Zip	:	06239-3500
Country	:	US
Telephone Number	:	347-429-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5629 METROPOLITAN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-1975
Country	:	US
Telephone Number	:	718-418-0300
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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Directions to “ KIM CAPENA ” Practice Location

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