Provider Demographics
NPI:1871570788
Name:CAPPETTA, JULIE ANNE (RPT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:CAPPETTA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4401
Mailing Address - Country:US
Mailing Address - Phone:203-937-6150
Mailing Address - Fax:203-937-8517
Practice Address - Street 1:544 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4401
Practice Address - Country:US
Practice Address - Phone:203-937-6150
Practice Address - Fax:203-937-8517
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004223393Medicaid
CT080006014CT2OtherANTHEM BCBS
P00216849OtherRAILROAD MEDICARE
CT004223393Medicaid