Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10255 | MN |
Y | 225100000X | Physical Therapist | 299327 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT023860 | PA |
NPI | 1083015127 |
---|---|
Provider Name | Mr. Elliott Caponetti |
First Address | San Diego, CA 92117-5358 |
Second Address | San Diego, CA 92117-5358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2014 |
Last Update Date | 10/06/2021 |