Individual
JENNY DARICE CAPOUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
805 SAINT JOHN ST, COTTAGE GROVE, WI 53527-8912
(608) 839-1316
Mailing address
4502 MILWAUKEE ST, MADISON, WI 53714-2133
(608) 249-7622
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
971-019
WI
Other
Enumeration date
12/11/2007
Last updated
12/11/2007
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