| Organization Name: | PRIME MOVERS REHAB, INC. |
| NPI Number: | 1114127511 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOVENA SUSON-AGANON (PRESIDENT / CLINICAL DIRECTOR) |
| Mailing Address: | 1091 Port Malabar Blvd Ne Ste 2 Palm Bay |
| State: | FL US |
| Postal Code: | 329055100 |
| Phone Number: | 3216749659 |
| Fax Number: | 3216749659 |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 07/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 9288 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |