MEDICARE: PRIME THERAPY LLC

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
1	251E00000X	Home Health Agency
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1538873294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME THERAPY LLC

Provider Business Mailing Address
First Line	:	6201 BONHOMME RD STE 268N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4376
Country	:	US
Telephone Number	:	713-665-8655
Fax Number	:	713-665-1938

Provider Business Practice Location Address
First Line	:	6201 BONHOMME RD STE 268N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4376
Country	:	US
Telephone Number	:	713-665-8655
Fax Number	:	713-665-1938

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	SAMSON A EBAI
Credential	:
Telephone Number	:	713-665-8655

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2026

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Directions to “PRIME THERAPY LLC ” Practice Location

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