Healthcare Provider Details

I. General information

NPI: 1780018424
Provider Name (Legal Business Name): PROSTAT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BERNVILLE RD
READING PA
19601-1113
US

IV. Provider business mailing address

1901 BERNVILLE RD
READING PA
19601-1113
US

V. Phone/Fax

Practice location:
  • Phone: 610-736-9000
  • Fax:
Mailing address:
  • Phone: 610-736-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MARISSA MARIE SHELLY
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 610-736-9000