Provider Demographics
NPI:1174544100
Name:KAPETAN, PETER (PT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KAPETAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1543
Mailing Address - Country:US
Mailing Address - Phone:603-622-0909
Mailing Address - Fax:603-622-2869
Practice Address - Street 1:22 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4987
Practice Address - Country:US
Practice Address - Phone:603-622-0909
Practice Address - Fax:603-622-2869
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH378693OtherMVP
NH08Y007652NH01OtherCIGNA
NH1136346OtherAETNA
NH30393150Medicaid
NH30393150Medicaid