Provider Demographics
NPI:1962141754
Name:REPKO, NOAH DAVID
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:DAVID
Last Name:REPKO
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 1:2614 DOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1223
Mailing Address - Country:US
Mailing Address - Phone:814-823-5874
Mailing Address - Fax:
Practice Address - Street 1:2614 DOBBINS RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1223
Practice Address - Country:US
Practice Address - Phone:814-823-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29557225100000X
PAPT030377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT030377OtherPHYSICAL THERAPY LICENSE