Provider Demographics
NPI:1265675235
Name:PRIME PHYSICAL THERAPY & REHABILITATION,P.C
Entity Type:Organization
Organization Name:PRIME PHYSICAL THERAPY & REHABILITATION,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-2224
Mailing Address - Street 1:6259 108TH ST
Mailing Address - Street 2:1K
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1357
Mailing Address - Country:US
Mailing Address - Phone:718-897-6869
Mailing Address - Fax:718-275-5100
Practice Address - Street 1:6259 108TH ST
Practice Address - Street 2:1K
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1357
Practice Address - Country:US
Practice Address - Phone:718-897-6869
Practice Address - Fax:718-275-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy