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NPI Code Detail

MEDICARE: JORDAN CUMBO DPT

MEDICARE: JORDAN CUMBO 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1699404517
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN CUMBO DPT
Provider Business Mailing Address
First Line : 2201 PENNSYLVANIA AVE APT 603
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-3523
Country : US
Telephone Number : 570-362-2324
Fax Number :
Provider Business Practice Location Address
First Line : 2 FRANKLIN TOWN BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-1238
Country : US
Telephone Number : 215-563-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2022
Last Update Date : 06/07/2022

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