MEDICARE: PRIME MEDICAL REHAB CENTER, INC

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	PT 17717	FL
2	225200000X	Physical Therapy Assistant	PTA16340	FL
3	208VP0000X	Pain Medicine Physician	ME34371	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC4364	OTHER	FL	CLINIC LICENSE

General Provider Information

NPI Number	:	1730240318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL REHAB CENTER, INC

Provider Business Mailing Address
First Line	:	2331 N STATE ROAD 7
Second Line	:	SUITE 118
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-3748
Country	:	US
Telephone Number	:	954-535-7676
Fax Number	:	954-535-2909

Provider Business Practice Location Address
First Line	:	2331 N STATE ROAD 7
Second Line	:	SUITE 118
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-3748
Country	:	US
Telephone Number	:	954-535-7676
Fax Number	:	954-535-2909

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CYRIL PHILIP CHORATH
Credential	:
Telephone Number	:	954-535-7676

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/11/2025

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