Provider Demographics
NPI:1336449800
Name:PLATINUM PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:PLATINUM PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-697-9578
Mailing Address - Street 1:6 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4514
Mailing Address - Country:US
Mailing Address - Phone:631-697-9578
Mailing Address - Fax:516-530-1943
Practice Address - Street 1:6 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-4514
Practice Address - Country:US
Practice Address - Phone:631-697-9578
Practice Address - Fax:631-697-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty