Active NPI
Jenny Darice Capouch
- Physical Therapy Assistant
- Cottage Grove, WI
National Provider Identifier
1821271016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 971-019
- Practice address
- 805 Saint John St
Cottage Grove, WI 53527-8912 - Phone
- (608) 839-1316
- NPI assigned
- Dec 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 971-019 | WI | Primary |
Addresses
Primary practice location
805 Saint John St
Cottage Grove, WI 53527-8912
Mailing address
4502 Milwaukee St
Madison, WI 53714-2133
Phone (608) 249-7622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 971-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1821271016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4502 MILWAUKEE ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537142133",
"telephone_number": "608-249-7622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 SAINT JOHN ST",
"city": "COTTAGE GROVE",
"state": "WI",
"postal_code": "535278912",
"telephone_number": "608-839-1316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAPOUCH",
"first_name": "JENNY",
"middle_name": "DARICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-11",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "971-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cottage Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.