MEDICARE: HOLLIS DEL CAMPO DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01708300	NJ
2	225100000X	Physical Therapist	24108	MD
3	225100000X	Physical Therapist	025634	PA

General Provider Information

NPI Number	:	1346595808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIS DEL CAMPO DPT

Provider Business Mailing Address
First Line	:	2804 SOUTHAMPTON RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 SOUTHAMPTON RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1207
Country	:	US
Telephone Number	:	156-770-9302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/29/2020

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Directions to “ HOLLIS DEL CAMPO DPT” Practice Location

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