Provider Demographics
NPI:1316996713
Name:PRIME THERAPY INC
Entity type:Organization
Organization Name:PRIME THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-682-8388
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531
Mailing Address - Country:US
Mailing Address - Phone:850-682-8388
Mailing Address - Fax:850-682-7463
Practice Address - Street 1:4100 S FERDON BLVD
Practice Address - Street 2:STE A1
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5252
Practice Address - Country:US
Practice Address - Phone:850-682-8388
Practice Address - Fax:850-682-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885901900Medicaid
FLY901TOtherBCBS