Provider Demographics
NPI:1629105655
Name:CAPACI, THERESA M (PA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:CAPACI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 E. 17TH AVENUE, RM 4602
Mailing Address - Street 2:MAIL STOP B202
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-8936
Mailing Address - Fax:303-724-1593
Practice Address - Street 1:4600 E 9TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4067
Practice Address - Country:US
Practice Address - Phone:303-329-8998
Practice Address - Fax:303-388-1865
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26956039Medicaid
COCO307032Medicare PIN