Provider Demographics
NPI:1063167856
Name:PRIME PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PRIME PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:570-817-0580
Mailing Address - Street 1:455 SUGARLOAF HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2910
Mailing Address - Country:US
Mailing Address - Phone:570-817-0580
Mailing Address - Fax:
Practice Address - Street 1:455 SUGARLOAF HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2910
Practice Address - Country:US
Practice Address - Phone:570-817-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-20
Last Update Date:2022-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy