Healthcare Provider Details

I. General information

NPI: 1336449800
Provider Name (Legal Business Name): PLATINUM PHYSICAL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STAFFORD DR
HUNTINGTN STA NY
11746-4514
US

IV. Provider business mailing address

6 STAFFORD DR
HUNTINGTN STA NY
11746-4514
US

V. Phone/Fax

Practice location:
  • Phone: 631-697-9578
  • Fax: 631-697-9578
Mailing address:
  • Phone: 631-697-9578
  • Fax: 516-530-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BOYD THOMAS DYER
Title or Position: OWNER/DIRECTOR
Credential: PT
Phone: 516-697-9578