Provider Demographics
NPI:1821446527
Name:PRIMETIME PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PRIMETIME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-821-5300
Mailing Address - Street 1:134 MEADOW FRK
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE
Mailing Address - State:KY
Mailing Address - Zip Code:41838-9067
Mailing Address - Country:US
Mailing Address - Phone:606-821-5300
Mailing Address - Fax:606-855-4884
Practice Address - Street 1:134 MEADOW FRK
Practice Address - Street 2:
Practice Address - City:MILLSTONE
Practice Address - State:KY
Practice Address - Zip Code:41838-9067
Practice Address - Country:US
Practice Address - Phone:606-821-5300
Practice Address - Fax:606-855-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004507252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency