Basic Information
| Provider Information | |||||||||
| NPI: | 1316427834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REPASKY | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | MAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 N 11TH ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984031223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194333263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3801 5TH ST SE STE 220 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983742106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534454258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.