NPIMap

Organization Active NPI

Northern Libeties Wellness Center

  • Physical Therapy Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1346668530
Registry record updated Apr 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
MD 038770L Issued in PA
Legal business name
NORTHERN LIBETIES WELLNESS CENTER
Practice address
520 N Delaware Ave
Suite 202
Philadelphia, PA 19123-4226
Phone
(215) 239-3097
Fax
(215) 239-3098
NPI assigned
Apr 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wayne Gibbons, MD
Title
Owner
Phone
21523930697

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X MD 038770L PA Primary
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

520 N Delaware Ave
Suite 202
Philadelphia, PA 19123-4226

Mailing address

520 N Delaware Ave
Suite 202
Philadelphia, PA 19123-4226
Phone (215) 239-3097

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1346668530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N DELAWARE AVE",
            "address_2": "SUITE 202",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234226",
            "telephone_number": "215-239-3097",
            "fax_number": "215-239-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N DELAWARE AVE",
            "address_2": "SUITE 202",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234226",
            "telephone_number": "215-239-3097",
            "fax_number": "215-239-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIBETIES WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "21523930697",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "PA",
            "license": "MD 038770L",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.