Healthcare Provider Details

I. General information

NPI: 1215069059
Provider Name (Legal Business Name): JOSEPH JOHN REPAY MD, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 9TH ST N #308
NAPLES FL
34102-5627
US

IV. Provider business mailing address

599 9TH ST N #308
NAPLES FL
34102-5627
US

V. Phone/Fax

Practice location:
  • Phone: 239-643-7888
  • Fax: 239-643-4744
Mailing address:
  • Phone: 239-643-7888
  • Fax: 239-643-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME127276
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21264
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: