Provider Demographics
NPI:1447658430
Name:CAPPS, EDWARD ALLEN (PTA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
Last Name:CAPPS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 AVALON PARK EAST BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9374
Mailing Address - Country:US
Mailing Address - Phone:407-284-4362
Mailing Address - Fax:188-841-3892
Practice Address - Street 1:3680 AVALON PARK EAST BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9374
Practice Address - Country:US
Practice Address - Phone:407-284-4362
Practice Address - Fax:188-841-3892
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20338171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor