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General NPI Number Information
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NPI Number | 1124016043
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Entity Type | Individual
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Provider Name | MR. JOHN RICHARD WORLEY
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 925 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4216
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Country | US
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Telephone | 267-339-3731
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Fax |
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Provider Business Mailing Address
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Address Line | 821 WYNGATE RD
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City | SOMERDALE
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State | NJ
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Zip | 08083-2414
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Country | US
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Telephone | 856-627-1759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT000189A
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MTOOO47700
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License Number State | NJ
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