MEDICARE: PRIME PHYSICAL THERAPY & SPORTS PERFORMANCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1528750643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME PHYSICAL THERAPY & SPORTS PERFORMANCE

Provider Business Mailing Address
First Line	:	3859 SHARON COPLEY RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9779
Country	:	US
Telephone Number	:	440-665-3687
Fax Number	:

Provider Business Practice Location Address
First Line	:	3859 SHARON COPLEY RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9779
Country	:	US
Telephone Number	:	440-665-3687
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	AMY KRAHE
Credential	:	PT
Telephone Number	:	440-665-3687

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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Directions to “PRIME PHYSICAL THERAPY & SPORTS PERFORMANCE ” Practice Location

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