Individual provider · Type 1 NPI

Jaclyn Fantom

Physical Therapist · Philadelphia, PA

NPI number 1053296673 Active

Practice location

2410 S Broad St Ste 101
Philadelphia, PA 19145-4418

Call (215) 334-4400 Map

Mailing address

2734 S 11th St
Philadelphia, PA 19148-4902

Specialties and licenses

TaxonomyCodeLicense
Physical Therapist Primary 225100000XPT033564 (PA)

Physical Therapist: Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, r…

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About NPI 1053296673

Jaclyn Fantom's National Provider Identifier is 1053296673, issued on Aug 11, 2025. The primary taxonomy on file is Physical Therapist (225100000X), and the practice location is in Philadelphia, PA. The record was last updated on Aug 13, 2025.