Provider Demographics
NPI:1215130422
Name:GAMBONE, MARIA LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LYNN
Last Name:GAMBONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1329
Mailing Address - Country:US
Mailing Address - Phone:267-592-3190
Mailing Address - Fax:215-468-1850
Practice Address - Street 1:1200 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1329
Practice Address - Country:US
Practice Address - Phone:267-592-3190
Practice Address - Fax:215-468-1850
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01246000225100000X
MI5501015607225100000X
PAPT025238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist