Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACLYN FANTOM
ActiveJACLYN FANTOM is a Physical Therapy Assistant healthcare provider located in PHILADELPHIA, Pennsylvania. NPI 1053296673 is currently active in the NPPES registry. Verify at CMS.
Physical Therapy Assistant · PHILADELPHIA, PA
Registration Details
- NPI Number
- 1053296673
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 11, 2025 (1.013298725986 yrs)
- Last Updated
- Aug 13, 2025
- License
-
PT033564 (PA)
Practice Information
- Address
-
2410 S BROAD ST STE 101PHILADELPHIA, PA, 191454418Browse PA providers · Browse ZIP 19145
- Phone
- 2153344400
- Primary Specialty
-
Physical Therapy Assistant
225100000X
Other Physical Therapy Assistant Providers in PHILADELPHIA, PA
| Name | Credential | NPI |
|---|---|---|
| BEVERLY R. SAMSON | PT | 1972501336 |
| STEPHANIE SELLECCHIA | DPT | 1760480933 |
| MR. JOSEPH T. RUHL JR. | PT, ATC | 1639177744 |
| DR. SARAH BROOK WENGER | PT, DPT, OCS | 1417956137 |
| MRS. DEBORAH MARIE LYNCH-JOHNSON | PT, CERT MDT | 1962401521 |
| KIMBERLY WALLACE | PT | 1114926698 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.