Provider Demographics
NPI:1336830728
Name:PRIME STAR HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRIME STAR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRATHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUKALA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-603-2534
Mailing Address - Street 1:14973 TURNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4833
Mailing Address - Country:US
Mailing Address - Phone:858-603-2534
Mailing Address - Fax:
Practice Address - Street 1:14973 TURNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4833
Practice Address - Country:US
Practice Address - Phone:858-603-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty