Provider Demographics
NPI:1881086122
Name:REPPERT, JOSHUA DAVID (DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:REPPERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SUGARFOOT WAY
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6204
Mailing Address - Country:US
Mailing Address - Phone:865-365-4800
Mailing Address - Fax:865-365-4801
Practice Address - Street 1:109 SUGARFOOT WAY
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6204
Practice Address - Country:US
Practice Address - Phone:865-365-4800
Practice Address - Fax:865-365-4801
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist