Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jaclyn Fantom

Individual provider Physical Therapist · NPI 1053296673

Jaclyn Fantom is a Physical Therapist in Philadelphia, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2025.

Licensed in
PA
In the registry since
2025

Practice location Address checks out

2410 S Broad St Ste 101
Philadelphia, PA 19145-4418
Phone: (215) 334-4400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT033564 (PA)

Record details

NPI number1053296673
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 11, 2025
Last updated in NPPESAugust 13, 2025
Certification dateAugust 13, 2025

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