MEDICARE: DR. ROBIN KIM BANDURA PT, 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	PT013917L	PA

General Provider Information

NPI Number	:	1881693232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN KIM BANDURA PT, DPT

Provider Business Mailing Address
First Line	:	12 W WILLOW GROVE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3952
Country	:	US
Telephone Number	:	215-450-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 W WILLOW GROVE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3952
Country	:	US
Telephone Number	:	215-450-8717
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/02/2022

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