Provider Demographics
NPI:1639642374
Name:PRIME PHYSICAL THERAPY & SPORTS CARE LLC
Entity Type:Organization
Organization Name:PRIME PHYSICAL THERAPY & SPORTS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBACIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-383-8295
Mailing Address - Street 1:160 WHITE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1167
Mailing Address - Country:US
Mailing Address - Phone:732-383-8295
Mailing Address - Fax:
Practice Address - Street 1:160 WHITE RD STE 104
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1167
Practice Address - Country:US
Practice Address - Phone:732-383-8295
Practice Address - Fax:732-383-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty