Healthcare Provider Details

I. General information

NPI: 1518585843
Provider Name (Legal Business Name): ALEXANDRA REPPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 MILAN ST
EASTON PA
18045-5836
US

IV. Provider business mailing address

3011 MILAN ST
EASTON PA
18045-5836
US

V. Phone/Fax

Practice location:
  • Phone: 610-762-9605
  • Fax:
Mailing address:
  • Phone: 610-762-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: