Provider Demographics
NPI:1770396004
Name:PRIME RECOVERY THERAPY LLC
Entity type:Organization
Organization Name:PRIME RECOVERY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN CHLOE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMTENGCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:662-394-1459
Mailing Address - Street 1:2436 MOONSTRUCK PL
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3050
Mailing Address - Country:US
Mailing Address - Phone:662-394-1459
Mailing Address - Fax:
Practice Address - Street 1:2436 MOONSTRUCK PL
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3050
Practice Address - Country:US
Practice Address - Phone:662-394-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty