Healthcare Provider Details

I. General information

NPI: 1619587110
Provider Name (Legal Business Name): KATIE REPKO NORRIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4274 N VALDOSTA RD STE B
VALDOSTA GA
31602-6814
US

IV. Provider business mailing address

4274 N VALDOSTA RD STE B
VALDOSTA GA
31602-6814
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-3870
  • Fax:
Mailing address:
  • Phone: 229-433-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: