Provider Demographics
NPI:1881702660
Name:PRIMECARE REHAB INC
Entity type:Organization
Organization Name:PRIMECARE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPT
Authorized Official - Phone:386-673-1031
Mailing Address - Street 1:PO BOX 353813
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-3813
Mailing Address - Country:US
Mailing Address - Phone:386-673-1031
Mailing Address - Fax:386-673-1065
Practice Address - Street 1:570 MEMORIAL CIRCLE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-673-1031
Practice Address - Fax:386-673-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y 8721OtherBC/BS
Y 8721OtherBC/BS