Healthcare Provider Details

I. General information

NPI: 1790540169
Provider Name (Legal Business Name): SEAN RONALD REPAGE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ARDMORE BLVD STE 130
PITTSBURGH PA
15221-4637
US

IV. Provider business mailing address

4 HEMINGWAY ST
PITTSBURGH PA
15213-1144
US

V. Phone/Fax

Practice location:
  • Phone: 412-271-5000
  • Fax:
Mailing address:
  • Phone: 919-886-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT032101
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: