Provider Demographics
NPI:1083061006
Name:PROSPECT HEALTH ACCESS NETWORK, INC.
Entity Type:Organization
Organization Name:PROSPECT HEALTH ACCESS NETWORK, INC.
Other - Org Name:CROZER KEYSTONE PHYSICAL MEDICINE AND REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:485 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1161
Mailing Address - Country:US
Mailing Address - Phone:610-588-9222
Mailing Address - Fax:610-588-9033
Practice Address - Street 1:485 BALTIMORE PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1161
Practice Address - Country:US
Practice Address - Phone:610-588-9222
Practice Address - Fax:610-588-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty