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General NPI Number Information
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NPI Number | 1194012377
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Entity Type | Organization
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Legal Business Name | PLATINUM HEALTHCARE PHYSICAL MEDICINE, PLLC
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 5560 BEE RIDGE RD SUITE 7
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City | SARASOTA
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State | FL
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Zip | 34233-1508
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Country | US
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Telephone | 941-927-1123
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Fax | 941-927-1124
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Provider Business Mailing Address
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Address Line | 5560 BEE RIDGE RD SUITE 7
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City | SARASOTA
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State | FL
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Zip | 34233-1508
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Country | US
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Telephone | 941-927-1123
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. TAMARA LOGAN
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Credential |
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Telephone | 941-927-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME101995
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License Number State | FL
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