Provider Demographics
NPI:1356660146
Name:PRANA FUNCTIONAL MANUAL THERAPY, LLC
Entity Type:Organization
Organization Name:PRANA FUNCTIONAL MANUAL THERAPY, LLC
Other - Org Name:PRANA PHYSICAL THERAPY,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:CFMT, MSPT
Authorized Official - Phone:717-390-4822
Mailing Address - Street 1:617 N PRINCE ST
Mailing Address - Street 2:MAILBOX A
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4769
Mailing Address - Country:US
Mailing Address - Phone:717-390-4822
Mailing Address - Fax:717-390-4825
Practice Address - Street 1:617 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4769
Practice Address - Country:US
Practice Address - Phone:717-390-4822
Practice Address - Fax:717-390-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017185261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0128263160001Medicaid
PA1949525OtherHIGHMARK BLUE SHIELD
PA20088797OtherAMERIHEALTH MERCY
PA50093252OtherCAPITAL BLUE CROSS
PA181523OtherMEDICARE PTAN
PA50081775OtherCAPITAL BLUE CROSS PIN
PA1646932OtherHIGHMARK BLUE SHIELD
PA20080890OtherAMERIHEALTH MERCY
PA50081775OtherCAPITAL BLUE CROSS PIN
PA20080890OtherAMERIHEALTH MERCY