Healthcare Provider Details

I. General information

NPI: 1538372651
Provider Name (Legal Business Name): PRIME CARE PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CYPRESS RD STE 4
GOSHEN NY
10924-6815
US

IV. Provider business mailing address

PO BOX 4720
MIDDLETOWN NY
10941-8720
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-3484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019732
License Number StateNY

VIII. Authorized Official

Name: MS. GINA PALCONET
Title or Position: P.T.
Credential:
Phone: 845-294-3484