Provider Demographics
NPI:1194012377
Name:PLATINUM HEALTHCARE PHYSICAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:PLATINUM HEALTHCARE PHYSICAL MEDICINE, PLLC
Other - Org Name:PLATINUM HEALTHCARE PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-927-1123
Mailing Address - Street 1:5560 BEE RIDGE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1508
Mailing Address - Country:US
Mailing Address - Phone:941-927-1123
Mailing Address - Fax:
Practice Address - Street 1:5560 BEE RIDGE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1508
Practice Address - Country:US
Practice Address - Phone:941-927-1123
Practice Address - Fax:941-927-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101995208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty