MEDICARE: PRIME MOTION PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	224Z00000X	Occupational Therapy Assistant
4	225100000X	Physical Therapist
5	225200000X	Physical Therapy Assistant
6	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1356040687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MOTION PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	24 DICKERSON LN
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-4217
Country	:	US
Telephone Number	:	224-436-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 BROOK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-2508
Country	:	US
Telephone Number	:	224-436-0405
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR /OWNER
Name	:	NILKANTH THAKER
Credential	:
Telephone Number	:	224-436-0405

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	01/10/2024

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