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General NPI Number Information
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NPI Number | 1073558797
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Entity Type | Organization
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Legal Business Name | PLATINUM REHABILITATION, INC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 CENTURY BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-2262
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Country | US
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Telephone | 561-697-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CENTURY BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-2262
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Country | US
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Telephone | 561-697-3131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRADFORD RUSSELL ESTRA
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Credential |
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Telephone | 561-697-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | FL
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