Bustleton Physical & Sports Rehab

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BUSTLETON PHYSICAL & SPORTS REHAB

Practice address

9622 Bustleton Ave
Ste 4
Philadelphia, PA 19115-3100

Phone

(215) 677-8258

Fax

(215) 673-4966

NPI assigned

Dec 8, 2006

Organization subpart

No

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

Authorized official

Name

Donna Marie Gavarone, DO

Title

Owner and President

Phone

(215) 676-7067

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780743302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9622 BUSTLETON AVE",
            "address_2": "STE 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153100",
            "telephone_number": "215-677-8258",
            "fax_number": "215-673-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9622 BUSTLETON AVE",
            "address_2": "STE 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153100",
            "telephone_number": "215-677-8258",
            "fax_number": "215-673-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSTLETON PHYSICAL & SPORTS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAVARONE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER AND PRESIDENT",
        "authorized_official_telephone_number": "215-676-7067",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.