Healthcare Provider Details

I. General information

NPI: 1083077853
Provider Name (Legal Business Name): TIFFANY REPSHER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAKE AVE
MONTROSE PA
18801-1452
US

IV. Provider business mailing address

9562 ROUTE 467
LE RAYSVILLE PA
18829-7890
US

V. Phone/Fax

Practice location:
  • Phone: 305-753-9558
  • Fax:
Mailing address:
  • Phone: 305-753-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG001858
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: