Provider Demographics
NPI:1245205368
Name:PRIME TIME PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PRIME TIME PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-995-8844
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:EASTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40018-0078
Mailing Address - Country:US
Mailing Address - Phone:502-995-8844
Mailing Address - Fax:502-995-8842
Practice Address - Street 1:10116 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3948
Practice Address - Country:US
Practice Address - Phone:502-995-8844
Practice Address - Fax:502-995-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5711730001Medicare NSC