Healthcare Provider Details

I. General information

NPI: 1891592721
Provider Name (Legal Business Name): CAITLYN ROSE REPPERT-MOYER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 CHEW ST
ALLENTOWN PA
18102-3698
US

IV. Provider business mailing address

49 LONGVIEW RD
BOYERTOWN PA
19512-8091
US

V. Phone/Fax

Practice location:
  • Phone: 610-969-4992
  • Fax:
Mailing address:
  • Phone: 484-374-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: