Provider Demographics
NPI:1649873043
Name:PLATINUM REHAB PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:PLATINUM REHAB PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:949-793-3400
Mailing Address - Street 1:PO BOX 11240
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1240
Mailing Address - Country:US
Mailing Address - Phone:949-793-3400
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE J108
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7919
Practice Address - Country:US
Practice Address - Phone:949-793-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATINUM REHAB PHYSICAL THERAPY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty