Provider Demographics
NPI:1639802887
Name:PRIME PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PRIME PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MELROY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:620-770-1248
Mailing Address - Street 1:14915 W 82ND TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-5804
Mailing Address - Country:US
Mailing Address - Phone:620-770-1248
Mailing Address - Fax:
Practice Address - Street 1:22378 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-3148
Practice Address - Country:US
Practice Address - Phone:913-592-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy