Organization
PROSTAT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA MARIE SHELLY M.S. CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(610) 736-9000
Entity
Organization
Contact information
Practice address
1901 BERNVILLE RD, READING, PA 19601-1113
(610) 736-9000
Mailing address
1901 BERNVILLE RD, READING, PA 19601-1113
(610) 736-9000
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024232050001
—
PA
05
—
1024232050002
—
PA
05
—
1024232050003
—
PA
05
—
343800000X
—
PA
Enumeration date
08/29/2013
Last updated
08/27/2014
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