Provider Demographics
NPI:1891124467
Name:REPASZ, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:REPASZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CLARE AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3313
Mailing Address - Country:US
Mailing Address - Phone:360-377-3951
Mailing Address - Fax:360-377-5443
Practice Address - Street 1:2701 CLARE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3313
Practice Address - Country:US
Practice Address - Phone:360-377-3951
Practice Address - Fax:360-377-5443
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160251625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant