MEDICARE: MRS. JACQUELINE KAPOLNEK MPT

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	5501003403	MI

General Provider Information

NPI Number	:	1730156365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE KAPOLNEK MPT

Provider Business Mailing Address
First Line	:	12550 BURNS RD
Second Line	:
City	:	CARLETON
State	:	MI
Zip	:	48117
Country	:	US
Telephone Number	:	734-654-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 NORTH MONROE ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162
Country	:	US
Telephone Number	:	734-241-1400
Fax Number	:	734-241-1414

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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