Healthcare Provider Details

I. General information

NPI: 1932466729
Provider Name (Legal Business Name): NEUROLOGY PSYCHIATRY AND BALANCE THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SKIPPACK PIKE PAREC PLAZA, SUITE 130
BLUE BELL PA
19422-1704
US

IV. Provider business mailing address

725 SKIPPACK PIKE PAREC PLAZA, SUITE 130
BLUE BELL PA
19422-1704
US

V. Phone/Fax

Practice location:
  • Phone: 215-591-0700
  • Fax:
Mailing address:
  • Phone: 215-591-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name: SONYA KNIGHT
Title or Position: OWNER
Credential: DO
Phone: 215-591-0700