| Entity Name: | PRIME PHYSICAL THERAPY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Sep 2001 (23 years ago) |
| Document Number: | P01000095253 |
| FEI/EIN Number | 522344261 |
| Address: | 18435 Merseyside Loop, Land O Lakes, FL, 34638, US |
| Mail Address: | PO BOX 272689, TAMPA, FL, 33688, UN |
| ZIP code: | 34638 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427259779 | 2007-05-31 | 2015-10-28 | PO BOX 272689, TAMPA, FL, 336882689, US | 4895 W WATERS AVE, SUITE E, TAMPA, FL, 336341316, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-932-3315 |
Authorized person
| Name | MRS. ROBIN LYNN JOHNSON |
| Role | OWNER |
| Phone | 8139323315 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 222535 |
| State | FL |
| Issuer | CIGNA |
| Number | 2906996 |
| State | FL |
| Issuer | DEPT OF LABOR |
| Number | 350376000 |
| State | FL |
| Issuer | NON-PAR BCBS |
| Number | Y0571 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Doris Kevin | Agent | 18435 Merseyside Loop, Land O Lakes, FL, 34638 |
| Name | Role | Address |
|---|---|---|
| JOHNSON ROBIN | Director | 3316 STONEMAN COOP, LAND O LAKES, FL, 34638 |
| DORIS KEVIN | Director | 18435 Merseyside Loop, Land O Lakes, FL, 34638 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
