Provider Demographics
NPI:1306942990
Name:CAPERTON, SHENNAH BARBARA (MPT)
Entity type:Individual
Prefix:
First Name:SHENNAH
Middle Name:BARBARA
Last Name:CAPERTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DESALES ST NW FL 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4405
Mailing Address - Country:US
Mailing Address - Phone:202-630-0378
Mailing Address - Fax:855-350-5613
Practice Address - Street 1:1705 DESALES ST NW FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4405
Practice Address - Country:US
Practice Address - Phone:202-630-0378
Practice Address - Fax:855-350-5613
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21841225100000X
DCPT871834225100000X
GAPT008197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022705000Medicaid
FLGH621ZOtherMEDICARE PTAN