Healthcare Provider Details

I. General information

NPI: 1639309552
Provider Name (Legal Business Name): ELEANOR J REPETTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ARROWHEAD RD
DUXBURY MA
02332-5003
US

IV. Provider business mailing address

50 ARROWHEAD RD
DUXBURY MA
02332-5003
US

V. Phone/Fax

Practice location:
  • Phone: 781-934-0655
  • Fax:
Mailing address:
  • Phone: 781-934-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1693
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: