Provider Demographics
NPI:1295076917
Name:PRIME PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PRIME PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:PURVIS
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DMT
Authorized Official - Phone:225-388-5534
Mailing Address - Street 1:4606 JONES CREEK RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1554
Mailing Address - Country:US
Mailing Address - Phone:225-388-5534
Mailing Address - Fax:
Practice Address - Street 1:14608 S HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2926
Practice Address - Country:US
Practice Address - Phone:225-388-5534
Practice Address - Fax:225-388-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06937261QP2000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty