Organization
PLATINUM PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R STEVENS DO (PARTNER)
(931) 393-2378
Entity
Organization
Contact information
Practice address
1816 N WASHINGTON ST, SUITE 101, TULLAHOMA, TN 37388
(931) 393-2378
(931) 455-9983
Mailing address
1816 N WASHINGTON ST, SUITE 101, TULLAHOMA, TN 37388
(931) 393-2378
(931) 455-9983
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT962
TN
225X00000X
Occupational Therapist
OT3437
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370356
—
TN
01
—
4207023
BLUE CROSS BLUE SHIELD TENNESSEE
TN
01
—
DQ1710
PALMETTO GBA-RAILROAD MEDICARE
TN
Enumeration date
06/05/2008
Last updated
08/25/2010
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