Healthcare Provider Details

I. General information

NPI: 1730240318
Provider Name (Legal Business Name): PRIME MEDICAL REHAB CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 N STATE ROAD 7 SUITE 118
LAUDERDALE LAKES FL
33313-3748
US

IV. Provider business mailing address

2331 N STATE ROAD 7 SUITE 118
LAUDERDALE LAKES FL
33313-3748
US

V. Phone/Fax

Practice location:
  • Phone: 954-535-7676
  • Fax: 954-535-2909
Mailing address:
  • Phone: 954-535-7676
  • Fax: 954-535-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME34371
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 17717
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA16340
License Number StateFL

VIII. Authorized Official

Name: MR. CYRIL PHILIP CHORATH
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-535-7676