Provider Demographics
NPI:1588787915
Name:KAPUSTA, VIRGINIA M (PT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:M
Last Name:KAPUSTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:M
Other - Last Name:KAPUSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1004 QUAKER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5804
Mailing Address - Country:US
Mailing Address - Phone:407-971-9235
Mailing Address - Fax:
Practice Address - Street 1:1004 QUAKER RIDGE CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5804
Practice Address - Country:US
Practice Address - Phone:407-971-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist