Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01174800 | NJ |
NPI | 1003238478 |
---|---|
Provider Name | Elizabeth Caputo |
First Address | West Orange, NJ 07052-1424 |
Second Address | West Orange, NJ 07052-1424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2014 |
Last Update Date | 20/01/2014 |