Provider Demographics
NPI:1699665281
Name:PRIME INJURY & SPORTS REHAB LLC
Entity type:Organization
Organization Name:PRIME INJURY & SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:COMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-910-4150
Mailing Address - Street 1:111 E MONUMENT AVE UNIT 604
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5784
Mailing Address - Country:US
Mailing Address - Phone:407-910-4150
Mailing Address - Fax:
Practice Address - Street 1:111 E MONUMENT AVE UNIT 604
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5784
Practice Address - Country:US
Practice Address - Phone:407-910-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty