Basic Information
| Provider Information | |||||||||
| NPI: | 1851957575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAPEC | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | MACKENZIE | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SPRING OAK CT | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274101817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366820104 | ||||||||
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| Practice Location | |||||||||
| Address1: | 233 BELL FORK RD STE E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285406471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102382259 | ||||||||
| FaxNumber: | 8882099322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9581 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.