Healthcare Provider Details

I. General information

NPI: 1487263109
Provider Name (Legal Business Name): PRIME CARE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WHITE OAK LN STE 54
OLD BRIDGE NJ
08857-1981
US

IV. Provider business mailing address

109 WHITE OAK LN STE 54
OLD BRIDGE NJ
08857-1981
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-7878
  • Fax: 732-679-4332
Mailing address:
  • Phone: 732-679-7878
  • Fax: 732-679-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NEETABEN M KHUNT
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 708-663-9200