Provider Demographics
NPI:1487696167
Name:SCAPELLATO, CHARLES A
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:SCAPELLATO
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 1:2301 GETTYSBURG DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7394
Mailing Address - Country:US
Mailing Address - Phone:856-691-9915
Mailing Address - Fax:856-691-5241
Practice Address - Street 1:44 S STATE ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4851
Practice Address - Country:US
Practice Address - Phone:856-691-9915
Practice Address - Fax:856-691-5241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01084000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist