Provider Demographics
NPI:1518736578
Name:MACIBORSKI, MEGAN E GIBBONS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E GIBBONS
Last Name:MACIBORSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GIBBONS MACIBORSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:493 HARMON RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4202
Mailing Address - Country:US
Mailing Address - Phone:215-219-9525
Mailing Address - Fax:
Practice Address - Street 1:493 HARMON RD UNIT C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4202
Practice Address - Country:US
Practice Address - Phone:215-219-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist