Provider Demographics
NPI:1104701135
Name:CAPATI, JETHRO ANGELO
Entity type:Individual
Prefix:
First Name:JETHRO
Middle Name:ANGELO
Last Name:CAPATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 BROWN NODDY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4316
Mailing Address - Country:US
Mailing Address - Phone:813-869-1294
Mailing Address - Fax:
Practice Address - Street 1:1902 JAMES L REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7101
Practice Address - Country:US
Practice Address - Phone:813-652-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist