Provider Demographics
NPI:1043267289
Name:REPLAY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REPLAY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:MOSSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:765-455-2122
Mailing Address - Street 1:2122 S DIXON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6409
Mailing Address - Country:US
Mailing Address - Phone:765-455-2122
Mailing Address - Fax:765-455-3122
Practice Address - Street 1:2122 S DIXON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6409
Practice Address - Country:US
Practice Address - Phone:765-455-2122
Practice Address - Fax:765-455-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy