Healthcare Provider Details

I. General information

NPI: 1336723691
Provider Name (Legal Business Name): MARIEL R REPETTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13073 SALK WAY
ORLANDO FL
32827-7815
US

IV. Provider business mailing address

13073 SALK WAY
ORLANDO FL
32827-7815
US

V. Phone/Fax

Practice location:
  • Phone: 407-497-0386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: