Kelly Dawn Repka, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01140000 Issued in NJ

Practice address

290 Red School LN
Phillipsburg, NJ 08865-2276

Phone

(908) 859-2800

Fax

(908) 859-1866

NPI assigned

Mar 19, 2007

Last updated

Jan 17, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Miss Kelly Dawn Degenhardt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232150400000",
    "number": "1649394941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 COSENZA CT",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180408094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 RED SCHOOL LN",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652276",
            "telephone_number": "908-859-2800",
            "fax_number": "908-859-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REPKA",
        "first_name": "KELLY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01140000",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "017307",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DEGENHARDT",
            "middle_name": "DAWN",
            "prefix": "MISS",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Phillipsburg, NJ
• Providers in Phillipsburg, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.