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General NPI Number Information
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NPI Number | 1083911754
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Entity Type | Organization
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Legal Business Name | PRIMETIME PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 1578 VENICE AVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-5739
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Country | US
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Telephone | 850-862-1999
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Fax | 850-862-1999
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Provider Business Mailing Address
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Address Line | 1578 VENICE AVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-5739
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Country | US
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Telephone | 850-862-1999
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Fax | 850-862-1999
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORY M SCOTT
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Credential | P.T.
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Telephone | 850-862-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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