Provider Demographics
NPI:1275206138
Name:DRIVEN GOLF PERFORMANCE AND SPORTS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:DRIVEN GOLF PERFORMANCE AND SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:559-920-5306
Mailing Address - Street 1:1470 MARY CT
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-2373
Mailing Address - Country:US
Mailing Address - Phone:559-920-5306
Mailing Address - Fax:559-471-3727
Practice Address - Street 1:1470 MARY CT
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-2373
Practice Address - Country:US
Practice Address - Phone:559-920-5306
Practice Address - Fax:559-471-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy