Provider Demographics
NPI:1043756711
Name:REPKA, CLARENCE D (BS,AT,LAT)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:D
Last Name:REPKA
Suffix:
Gender:M
Credentials:BS,AT,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CAVALIER BLVD
Mailing Address - Street 2:SUITE NUMBER 1700
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1645
Mailing Address - Country:US
Mailing Address - Phone:859-283-0707
Mailing Address - Fax:859-647-3022
Practice Address - Street 1:68 CAVALIER BLVD
Practice Address - Street 2:SUITE NUMBER 1700
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1645
Practice Address - Country:US
Practice Address - Phone:859-283-0707
Practice Address - Fax:859-647-3022
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT1372255A2300X
OHAT0035832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer