Provider Demographics
NPI:1194124891
Name:REPKO, ALYSON KIMBRELL (DPT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:KIMBRELL
Last Name:REPKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:NOEL
Other - Last Name:KIMBRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5690 STATE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6002
Mailing Address - Country:US
Mailing Address - Phone:678-395-4202
Mailing Address - Fax:678-395-4725
Practice Address - Street 1:5690 STATE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-6002
Practice Address - Country:US
Practice Address - Phone:678-395-4202
Practice Address - Fax:678-395-4725
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist