Healthcare Provider Details

I. General information

NPI: 1083061006
Provider Name (Legal Business Name): PROSPECT HEALTH ACCESS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 BALTIMORE PIKE SUITE 202
GLEN MILLS PA
19342-1161
US

IV. Provider business mailing address

485 BALTIMORE PIKE SUITE 202
GLEN MILLS PA
19342-1161
US

V. Phone/Fax

Practice location:
  • Phone: 610-588-9222
  • Fax: 610-588-9033
Mailing address:
  • Phone: 610-588-9222
  • Fax: 610-588-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249