Basic Information
| Provider Information | |||||||||
| NPI: | 1184286932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITOL PHYSICAL THERAPY SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 E VERONA AVE | ||||||||
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| City: | VERONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535931227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088486628 | ||||||||
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| Practice Location | |||||||||
| Address1: | 416 E VERONA AVE | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535931227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088486628 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOMBARDO | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6088486628 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT,DPT,OCS,WCS | ||||||||
| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.