Healthcare Provider Details

I. General information

NPI: 1790481745
Provider Name (Legal Business Name): HRT PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTH HENDERSON ROAD THE MERION BUILDING SUITE 110
KING OF PRUSSIA PA
19406
US

IV. Provider business mailing address

700 SOUTH HENDERSON ROAD THE MERION BUILDING SUITE 110
KING OF PRUSSIA PA
19406
US

V. Phone/Fax

Practice location:
  • Phone: 267-201-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 702-818-0446