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General NPI Number Information
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NPI Number | 1639718182
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Entity Type | Organization
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Legal Business Name | PROSOURCEPT LLC
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 421 W 5TH AVE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1671
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Country | US
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Telephone | 215-479-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W 5TH AVE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1671
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Country | US
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Telephone | 215-479-0119
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER, MANAGER
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Name | BENJAMIN PETER WHITE
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Credential | PT
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Telephone | 215-479-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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