Individual
JANESSA CAPOZZOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFO
Contact information
Practice address
115 RUTT RD, BANGOR, PA 18013-9603
(610) 216-3916
Mailing address
115 RUTT RD, BANGOR, PA 18013-9603
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
CFO04693
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008381761
ORTHOTIC FITTER
PA
Enumeration date
05/12/2021
Last updated
05/12/2021
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