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General NPI Number Information
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NPI Number | 1316563943
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Entity Type | Organization
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Legal Business Name | PLATINUM THERAPY & PERFORMANCE CENTER LLC
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 296 BAXLEY RD
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City | SAINT PAULS
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State | NC
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Zip | 28384-6766
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Country | US
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Telephone | 910-740-5882
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Fax |
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Provider Business Mailing Address
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Address Line | 296 BAXLEY RD
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City | SAINT PAULS
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State | NC
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Zip | 28384-6766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HENRY EDWARDS
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Credential | ATC, LAT
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Telephone | 910-740-5882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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