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:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-897-6869
Mailing Address - Street 1:6923 168TH STREET
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:347-730-4606
Mailing Address - Fax:866-310-5525
Practice Address - Street 1:6536 99TH STREET
Practice Address - Street 2:SUITE 1D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4316
Practice Address - Country:US
Practice Address - Phone:718-897-6869
Practice Address - Fax:718-685-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy