Jennifer Nicodemo-Capra, M.A., P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

015513 Issued in NY

Practice address

2 Walton Way
Lighthouse Physical Therapy, P.C.
Coram, NY 11727-1001

Phone

(631) 440-7678

Fax

(631) 331-0320

NPI assigned

Jan 26, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mrs. Jennifer Capra Professional name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lighthouse Physical Therapy, P.C.

  • Physical Therapist
  • Coram, NY
  • NPI 1265718332
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609922145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WALTON WAY",
            "address_2": "LIGHTHOUSE PHYSICAL THERAPY, P.C.",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117271001",
            "telephone_number": "631-440-7678",
            "fax_number": "631-331-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 WALTON WAY",
            "address_2": "LIGHTHOUSE PHYSICAL THERAPY, P.C.",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117271001",
            "telephone_number": "631-440-7678",
            "fax_number": "631-331-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMO-CAPRA",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "M.A., P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015513-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02486193",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "A100063588",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CAPRA",
            "prefix": "MRS.",
            "credential": "M.A.,P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Michael Nelin, DC
• Neva T Bolding
• Adam Newman
• Thao Nguyen, NPP
• Catherine Marie Nicholas, LPN
• Victoria Nielsen, LMSW
• Kathryn Nill
• Emily Noren
• NP3 Health & Wellness Inc.
• Imani Alexia Nunez

• Physical Therapist in Coram, NY
• Providers in Coram, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.