**Already participating in-network providers are authorized to use this registration request form**
Request to join ATAP’s network: https://www.alliedtrades-online.com/provider-request-to-join-network/
Any out-of-network providers please contact us at 215-677-8820 -or- email email@example.com
Please provide us with the information requested below and click submit. We will review your registration request, and you will receive an email notification to let you know if you have been approved. Once approved, you will be able to use our website to request authorizations, request re-authorizations, and check member benefits.
All fields are required