Provider Demographics
NPI:1730284100
Name:DAVID TRUMBORE, PT, DPT, PC
Entity type:Organization
Organization Name:DAVID TRUMBORE, PT, DPT, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRUMBORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:215-947-2099
Mailing Address - Street 1:1800 BYBERRY ROAD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-947-2099
Mailing Address - Fax:267-722-8221
Practice Address - Street 1:1800 BYBERRY ROAD
Practice Address - Street 2:SUITE 703
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-947-2099
Practice Address - Fax:267-722-8221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID TRUMBORE PT DPT PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2719098000OtherIBC
PAUL1860368OtherHIGHMARK