Healthcare Provider Details

I. General information

NPI: 1316427834
Provider Name (Legal Business Name): CASSANDRA MAE REPASKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 5TH ST SE STE 220
PUYALLUP WA
98374-2106
US

IV. Provider business mailing address

1415 N 11TH ST APT 6
TACOMA WA
98403-1223
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-4258
  • Fax:
Mailing address:
  • Phone: 719-433-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: