Provider Demographics
NPI:1396446985
Name:TOOMER, JERRY (DAPT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:TOOMER
Suffix:
Gender:M
Credentials:DAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-1377
Mailing Address - Country:US
Mailing Address - Phone:215-668-9661
Mailing Address - Fax:
Practice Address - Street 1:1610 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-1377
Practice Address - Country:US
Practice Address - Phone:215-668-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000805261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy