Healthcare Provider Details

I. General information

NPI: 1770022568
Provider Name (Legal Business Name): DAVID GIRARDOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 WALNUT ST SUITE 200
PHILADELPHIA PA
19103-5457
US

IV. Provider business mailing address

1608 WALNUT ST SUITE 200
PHILADELPHIA PA
19103-5457
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-8717
  • Fax: 215-545-9355
Mailing address:
  • Phone: 215-545-8717
  • Fax: 215-545-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT025710
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: