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NPI Code Detail

MEDICARE: JIBIN JOHN

MEDICARE: JIBIN JOHN
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
1225200000XPhysical Therapy Assistant
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1770009631
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIBIN JOHN
Provider Business Mailing Address
First Line : 110 CHURCH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-2201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 110 CHURCH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-2201
Country : US
Telephone Number : 844-459-7589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2017
Last Update Date : 10/04/2024

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Directions to “ JIBIN JOHN ” Practice Location

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