Healthcare Provider Details

I. General information

NPI: 1083604912
Provider Name (Legal Business Name): ALAN EDWARD DIAMOND ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E BUTLER AVE
DOYLESTOWN PA
18901-2607
US

IV. Provider business mailing address

700 E BUTLER AVE
DOYLESTOWN PA
18901-2607
US

V. Phone/Fax

Practice location:
  • Phone: 215-489-2361
  • Fax: 215-489-2361
Mailing address:
  • Phone: 215-489-2361
  • Fax: 215-489-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00043000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005638
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: