Healthcare Provider Details

I. General information

NPI: 1487701090
Provider Name (Legal Business Name): TERRY L RZEPKOWSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 US HIGHWAY 98 N
LAKELAND FL
33805-2103
US

IV. Provider business mailing address

407 LAKE VISTA DR
AUBURNDALE FL
33823-5745
US

V. Phone/Fax

Practice location:
  • Phone: 863-665-8881
  • Fax:
Mailing address:
  • Phone: 813-944-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23728
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: