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General NPI Number Information
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NPI Number | 1245205368
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Entity Type | Organization
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Legal Business Name | PRIME TIME PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 10116 DIXIE HWY
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City | LOUISVILLE
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State | KY
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Zip | 40272-3948
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Country | US
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Telephone | 502-995-8844
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Fax | 502-995-8842
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Provider Business Mailing Address
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Address Line | PO BOX 78
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City | EASTWOOD
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State | KY
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Zip | 40018-0078
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Country | US
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Telephone | 502-995-8844
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Fax | 502-995-8842
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | JOSE P THOMAS
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Credential | PT
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Telephone | 502-995-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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