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NPI Code Detail

MEDICARE: PRIME MOVERS REHAB, INC.

MEDICARE: PRIME MOVERS REHAB, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center9288FL

General Provider Information

NPI Number : 1114127511
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME MOVERS REHAB, INC.
Provider Business Mailing Address
First Line : 919 PINE WALK CT NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4450
Country : US
Telephone Number : 321-674-9659
Fax Number : 321-674-9660
Provider Business Practice Location Address
First Line : 1091 PORT MALABAR BLVD NE STE 2
Second Line :
City : PALM BAY
State : FL
Zip : 32905-5100
Country : US
Telephone Number : 321-674-9659
Fax Number : 321-674-9659
Authorized Official
Title or Position : PRESIDENT / CLINICAL DIRECTOR
Name : MRS. LOVENA SUSON-AGANON
Credential : P.T.
Telephone Number : 321-674-9659
Provider Enumeration Date : 07/23/2007
Last Update Date : 07/23/2007

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Directions to “PRIME MOVERS REHAB, INC. ” Practice Location

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