Provider Demographics
NPI:1114805918
Name:PRIME REHAB PARTNERS, LLC
Entity type:Organization
Organization Name:PRIME REHAB PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOLLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:405-227-1280
Mailing Address - Street 1:301 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7297
Mailing Address - Country:US
Mailing Address - Phone:405-906-3375
Mailing Address - Fax:405-216-3743
Practice Address - Street 1:2419 N COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1357
Practice Address - Country:US
Practice Address - Phone:580-630-5933
Practice Address - Fax:580-630-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty