Healthcare Provider Details

I. General information

NPI: 1255052130
Provider Name (Legal Business Name): PLATINUM PERFORMANCE PRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 12/04/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27118 HIGHWAY 290 STE I
CYPRESS TX
77433-4930
US

IV. Provider business mailing address

27118 HIGHWAY 290 STE I
CYPRESS TX
77433-4978
US

V. Phone/Fax

Practice location:
  • Phone: 713-868-2766
  • Fax: 713-868-7575
Mailing address:
  • Phone: 281-918-7652
  • Fax: 281-918-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA AMINA KHORDAJI
Title or Position: OWNER
Credential:
Phone: 832-623-4107