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NPI Code Detail

MEDICARE: MRS. KELLY DAWN REPKA PT

MEDICARE: MRS. KELLY DAWN REPKA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01140000NJ
2225100000XPhysical Therapist017307PA

General Provider Information

NPI Number : 1649394941
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY DAWN REPKA PT
Provider Business Mailing Address
First Line : 1070 COSENZA CT
Second Line :
City : EASTON
State : PA
Zip : 18040-8094
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 290 RED SCHOOL LN
Second Line :
City : PHILLIPSBURG
State : NJ
Zip : 08865-2276
Country : US
Telephone Number : 908-859-2800
Fax Number : 908-859-1866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 01/17/2009

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