Healthcare Provider Details

I. General information

NPI: 1104075779
Provider Name (Legal Business Name): CELIA M. REPUCCI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BILLERICA RD
CHELMSFORD MA
01824-3604
US

IV. Provider business mailing address

147 MILK ST
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-6040
  • Fax: 978-244-6663
Mailing address:
  • Phone: 617-559-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: