Jaclyn Fantom
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 101Philadelphia, PA 19145-4418
Phone: (215) 334-4400
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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 number | 1053296673 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | No |
| NPI enumerated | August 11, 2025 |
| Last updated in NPPES | August 13, 2025 |
| Certification date | August 13, 2025 |
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