Provider Demographics
NPI:1528525029
Name:PT MEDICAL LLC
Entity type:Organization
Organization Name:PT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTELIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-1211
Mailing Address - Street 1:611 DRUID RD E STE 402B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3959
Mailing Address - Country:US
Mailing Address - Phone:727-461-1211
Mailing Address - Fax:
Practice Address - Street 1:611 DRUID RD E STE 402B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3959
Practice Address - Country:US
Practice Address - Phone:727-461-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier