Provider Demographics
NPI:1104891720
Name:PRIME HEALTH PHYSICAL THERAPY
Entity type:Organization
Organization Name:PRIME HEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:908-925-9700
Mailing Address - Street 1:822 N WOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4038
Mailing Address - Country:US
Mailing Address - Phone:908-925-9700
Mailing Address - Fax:908-663-2551
Practice Address - Street 1:822 N WOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4038
Practice Address - Country:US
Practice Address - Phone:908-925-9700
Practice Address - Fax:908-663-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022477Medicare PIN