Active NPI
Gregory Jeblonski, DPT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1568654069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-018686
- Practice address
- 3400 Aramingo Ave
Philadelphia, PA 19134-4531 - Phone
- (215) 203-1930
- Fax
- (215) 203-1931
- NPI assigned
- Aug 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-018686 | PA | Primary |
Addresses
Primary practice location
3400 Aramingo Ave
Philadelphia, PA 19134-4531
Mailing address
2 W 10TH St
Marcus Hook, PA 19061-4513
Phone (610) 859-8850
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30069505 | Other | PA | KEYSTONE MERCY |
| 3760849000 | Other | PA | IBC |
| 2147754 | Other | PA | HIGHMARK BLUE SHIELD |
| 301069 | Other | UNISON | |
| 102415114-0001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-018686 | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Therapy Services of Pennsylvania LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Dynamic Physical Therapy
- Physical Therapist
- Aston, PA
- NPI 1346477981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286928000000",
"number": "1568654069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 W 10TH ST",
"city": "MARCUS HOOK",
"state": "PA",
"postal_code": "190614513",
"telephone_number": "610-859-8850",
"fax_number": "610-859-7876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 ARAMINGO AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191344531",
"telephone_number": "215-203-1930",
"fax_number": "215-203-1931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEBLONSKI",
"first_name": "GREGORY",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-17",
"last_updated": "2010-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT-018686",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "30069505",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBC",
"identifier": "3760849000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "2147754",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "301069",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102415114-0001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
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- Steven Roland Jefferies, DDS
- Ann Jeffers
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.