Provider Demographics
NPI:1225350002
Name:REPUSTAFF
Entity Type:Organization
Organization Name:REPUSTAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-218-0654
Mailing Address - Street 1:8900 KEYSTONE XING
Mailing Address - Street 2:SUITE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7670
Mailing Address - Country:US
Mailing Address - Phone:317-218-0654
Mailing Address - Fax:317-218-0684
Practice Address - Street 1:8900 KEYSTONE XING
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7670
Practice Address - Country:US
Practice Address - Phone:317-218-0654
Practice Address - Fax:317-218-0684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy