1730284100 NPI number — DAVID TRUMBORE, PT, DPT, PC

Table of content: (NPI 1730284100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730284100 NPI number — DAVID TRUMBORE, PT, DPT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID TRUMBORE, PT, DPT, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
D/B/A ULTIMATE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730284100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 BYBERRY ROAD
Provider Second Line Business Mailing Address:
SUITE 703
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-947-2099
Provider Business Mailing Address Fax Number:
267-722-8221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 BYBERRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 703
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-947-2099
Provider Business Practice Location Address Fax Number:
267-722-8221
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRUMBORE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-947-2099

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT015126 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2719098000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: UL1860368 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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