Healthcare Provider Details

I. General information

NPI: 1710363593
Provider Name (Legal Business Name): EMMA PHIBBS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 DARTMOUTH AVE STE 1
SWARTHMORE PA
19081
US

IV. Provider business mailing address

413 DARTMOUTH AVE STE 1
SWARTHMORE PA
19081-1549
US

V. Phone/Fax

Practice location:
  • Phone: 302-722-5338
  • Fax:
Mailing address:
  • Phone: 302-722-5833
  • Fax: 302-444-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT024629
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: