Healthcare Provider Details

I. General information

NPI: 1033494513
Provider Name (Legal Business Name): ALAN THOMAS REPAS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 NW 13TH ST
GAINESVILLE FL
32609-2831
US

IV. Provider business mailing address

PO BOX 2578
WINTER HAVEN FL
33883-2578
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-0295
  • Fax:
Mailing address:
  • Phone: 813-267-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 64921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: