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General NPI Number Information
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NPI Number | 1356773006
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Entity Type | Individual
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Provider Name | THEODORE ZOMBOLAS PHD, LAC
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Gender | Male
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 234 MILL ST
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City | BRISTOL
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State | PA
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Zip | 19007-4809
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Country | US
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Telephone | 215-692-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 506 INMAN TER
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City | WILLOW GROVE
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State | PA
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Zip | 19090-3614
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Country | US
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Telephone | 215-962-0155
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | KO000526
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License Number State | PA
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