Healthcare Provider Details

I. General information

NPI: 1437271665
Provider Name (Legal Business Name): JILL MARIE REPINSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL MARIE MAYER PT

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 NORTH PORT WASHINGTON ROAD SPORT CLINIC PHYSICAL THERAPY INC
BAYSIDE WI
53217
US

IV. Provider business mailing address

4228 W PARKLAND AVE
BROWN DEER WI
53209
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-5794
  • Fax: 414-351-2770
Mailing address:
  • Phone: 414-354-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5860024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: