Provider Demographics
NPI:1619587110
Name:REPKO, KATIE LISABETH (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LISABETH
Last Name:REPKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 W MADERO ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1729
Mailing Address - Country:US
Mailing Address - Phone:480-703-3014
Mailing Address - Fax:
Practice Address - Street 1:351 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1861
Practice Address - Country:US
Practice Address - Phone:229-262-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist