Provider Demographics
NPI:1255052130
Name:PLATINUM PERFORMANCE PRO LLC
Entity type:Organization
Organization Name:PLATINUM PERFORMANCE PRO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:AMINA
Authorized Official - Last Name:KHORDAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-623-4107
Mailing Address - Street 1:27118 HIGHWAY 290 STE I
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4978
Mailing Address - Country:US
Mailing Address - Phone:281-918-7652
Mailing Address - Fax:281-918-7654
Practice Address - Street 1:27118 HIGHWAY 290 STE I
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4930
Practice Address - Country:US
Practice Address - Phone:713-868-2766
Practice Address - Fax:713-868-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty