Provider Demographics
NPI:1639429459
Name:REPNOY, LYDIA A (PT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:REPNOY
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 1:3 SPRINGHURST DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2261
Mailing Address - Country:US
Mailing Address - Phone:518-479-7172
Mailing Address - Fax:518-286-3798
Practice Address - Street 1:2827 ROUTE 9
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-7616
Practice Address - Fax:518-758-7557
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035376-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist