Healthcare Provider Details

I. General information

NPI: 1013958818
Provider Name (Legal Business Name): JEFFERY JADCZAK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 FRANKFORD AVE
PHILADELPHIA PA
19136-2786
US

IV. Provider business mailing address

2 W 10TH ST
MARCUS HOOK PA
19061-4513
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8900
  • Fax: 215-338-8923
Mailing address:
  • Phone: 610-859-8850
  • Fax: 610-859-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10001754
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015518
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: