Basic Information
| Provider Information | |||||||||
| NPI: | 1790988871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLATINUM PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | THE COMMONS AT OAKLANDS | ||||||||
| Address2: | 780 WEST LINCOLN HIGHWAY | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102700370 | ||||||||
| FaxNumber: | 6102700374 | ||||||||
| Practice Location | |||||||||
| Address1: | THE COMMONS AT OAKLANDS | ||||||||
| Address2: | 780 WEST LINCOLN HIGHWAY | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102700370 | ||||||||
| FaxNumber: | 6102700374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BONGIORNO | ||||||||
| AuthorizedOfficialFirstName: | KAMALA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6102700370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.