Provider Demographics
NPI:1679089205
Name:PLATINUM ORTHOTICS LLC
Entity Type:Organization
Organization Name:PLATINUM ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REP
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-226-5189
Mailing Address - Street 1:2000 NW 95TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2350
Mailing Address - Country:US
Mailing Address - Phone:888-226-5189
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 95TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2350
Practice Address - Country:US
Practice Address - Phone:888-226-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies