Organization Name: | PRIMETIME PHYSICAL THERAPY LLC |
NPI Number: | 1083911754 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CORY M SCOTT (PRESIDENT) |
Mailing Address: | 1578 Venice Ave Fort Walton Beach |
State: | FL US |
Postal Code: | 325475739 |
Phone Number: | 8508621999 |
Fax Number: | 8508621999 |
NPI Enumeration Date: | 02/16/2011 |
NPI Last Update Date: | 04/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |