Provider Demographics
NPI:1770022568
Name:GIRARDOT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GIRARDOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 WALNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5457
Mailing Address - Country:US
Mailing Address - Phone:215-545-8717
Mailing Address - Fax:215-545-9355
Practice Address - Street 1:1608 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5457
Practice Address - Country:US
Practice Address - Phone:215-545-8717
Practice Address - Fax:215-545-9355
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0257102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic