MEDICARE: JOSEPH M NOPHUT

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1386298776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M NOPHUT

Provider Business Mailing Address
First Line	:	215 ROBIN HOOD LN
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-1923
Country	:	US
Telephone Number	:	610-656-9038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N FRONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4603
Country	:	US
Telephone Number	:	610-656-9038
Fax Number	:

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

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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Directions to “ JOSEPH M NOPHUT ” Practice Location

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