Provider Demographics
NPI:1003936980
Name:REPASKY, LYNNE SOMERVILLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:SOMERVILLE
Last Name:REPASKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 E EXCHANGE PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5337
Mailing Address - Country:US
Mailing Address - Phone:770-493-6360
Mailing Address - Fax:770-493-6350
Practice Address - Street 1:2060 E. EXCHANGE PL
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4126
Practice Address - Country:US
Practice Address - Phone:770-493-6360
Practice Address - Fax:770-493-6350
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT002211Medicare ID - Type Unspecified