Organization
NORTHERN LIBETIES WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE GIBBONS MD (OWNER)
21523930697
Entity
Organization
Contact information
Practice address
520 N DELAWARE AVE, SUITE 202, PHILADELPHIA, PA 19123-4226
(215) 239-3097
(215) 239-3098
Mailing address
520 N DELAWARE AVE, SUITE 202, PHILADELPHIA, PA 19123-4226
(215) 239-3097
(215) 239-3098
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
MD 038770L
PA
261QP3300X
Pain Clinic/Center
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—
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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