MEDICARE: CHRISTOPHER SCOTT KAPELKA PTA

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	225200000X	Physical Therapy Assistant	PTA21122	FL

General Provider Information

NPI Number	:	1689849473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SCOTT KAPELKA PTA

Provider Business Mailing Address
First Line	:	1010 N SWALLOWTAIL DR APT 1701
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4158
Country	:	US
Telephone Number	:	386-956-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 VENTURE DR
Second Line	:	SUITE C
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3478
Country	:	US
Telephone Number	:	386-763-0084
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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