Provider Demographics
NPI:1215069059
Name:REPAY, JOSEPH JOHN (MD, PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:REPAY
Suffix:
Gender:M
Credentials:MD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 9TH ST N
Mailing Address - Street 2:#308
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5627
Mailing Address - Country:US
Mailing Address - Phone:239-643-7888
Mailing Address - Fax:239-643-4744
Practice Address - Street 1:599 9TH ST N
Practice Address - Street 2:#308
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5627
Practice Address - Country:US
Practice Address - Phone:239-643-7888
Practice Address - Fax:239-643-4744
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127276208M00000X, 207R00000X
FLPT21264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY048FOtherBCBS
FLY048FYOtherMEDICARE
FL018099200Medicaid
FLY048FYOtherMEDICARE