Provider Demographics
NPI:1205850906
Name:TRUMBORE, DAVID (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TRUMBORE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 BUSTLETON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3313
Mailing Address - Country:US
Mailing Address - Phone:215-464-6104
Mailing Address - Fax:215-464-9104
Practice Address - Street 1:10890 BUSTLETON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3313
Practice Address - Country:US
Practice Address - Phone:215-464-6104
Practice Address - Fax:215-464-9104
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005364L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068343M5PMedicare UPIN