Healthcare Provider Details

I. General information

NPI: 1386635076
Provider Name (Legal Business Name): A J TOLBERT & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SHADOW WOOD DR
DOWNINGTOWN PA
19335-4049
US

IV. Provider business mailing address

1100 SHADOW WOOD DR
DOWNINGTOWN PA
19335-4049
US

V. Phone/Fax

Practice location:
  • Phone: 610-269-6100
  • Fax: 610-873-6687
Mailing address:
  • Phone: 610-269-6100
  • Fax: 610-873-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT00281L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL000071L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD00378
License Number StatePA

VIII. Authorized Official

Name: DR. ALFRED JAMES TOLBERT
Title or Position: PRESIDENT
Credential: PHD
Phone: 610-269-6100