Provider Demographics
NPI:1295512598
Name:PRIME PERFORMANCE THERAPY LLC
Entity type:Organization
Organization Name:PRIME PERFORMANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHEBI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:407-808-4705
Mailing Address - Street 1:1079 SHOREVIEW CIR APT 209
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2454
Mailing Address - Country:US
Mailing Address - Phone:407-808-4705
Mailing Address - Fax:
Practice Address - Street 1:13054 HEMING WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-2712
Practice Address - Country:US
Practice Address - Phone:407-808-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy