Provider Demographics
NPI:1407180698
Name:PRIME CARE REHAB, INC
Entity Type:Organization
Organization Name:PRIME CARE REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIVINE
Authorized Official - Middle Name:OCAMPO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:1732-549-3993
Mailing Address - Street 1:3830 PARK AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2562
Mailing Address - Country:US
Mailing Address - Phone:732-549-3993
Mailing Address - Fax:
Practice Address - Street 1:3830 PARK AVE STE 207
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2562
Practice Address - Country:US
Practice Address - Phone:732-549-3993
Practice Address - Fax:732-549-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA008339000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy