Provider Demographics
NPI:1245383934
Name:KEPLER, MISTI ANNMARIE (DPT)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:ANNMARIE
Last Name:KEPLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 YAUPON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7329
Mailing Address - Country:US
Mailing Address - Phone:910-251-1818
Mailing Address - Fax:910-251-0462
Practice Address - Street 1:2246 YAUPON DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7329
Practice Address - Country:US
Practice Address - Phone:910-251-1818
Practice Address - Fax:910-251-0462
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0784POtherBCBS GROUP
NC250168OtherMEDICARE ID
NC2503655OtherMEDICARE GROUP
NC068E4OtherBCBS ID
NC7200002OtherMEDICAID GROUP
NC720784POtherMEDICAID GROUP