MEDICARE: MRS. MARIA LYNN GAMBONE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01246000	NJ
2	225100000X	Physical Therapist	5501015607	MI
3	225100000X	Physical Therapist	PT025238	PA

General Provider Information

NPI Number	:	1215130422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA LYNN GAMBONE DPT

Provider Business Mailing Address
First Line	:	1200 CONSTITUTION AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1329
Country	:	US
Telephone Number	:	267-592-3190
Fax Number	:	215-468-1850

Provider Business Practice Location Address
First Line	:	1200 CONSTITUTION AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1329
Country	:	US
Telephone Number	:	267-592-3190
Fax Number	:	215-468-1850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	02/15/2017

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