Provider Demographics
NPI:1518342625
Name:GOLF HEALTH & PERFORMANCE LLC
Entity Type:Organization
Organization Name:GOLF HEALTH & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-341-1133
Mailing Address - Street 1:2855B N 123RD LANE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383
Mailing Address - Country:US
Mailing Address - Phone:760-341-1133
Mailing Address - Fax:
Practice Address - Street 1:10225 E DESERT MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85262
Practice Address - Country:US
Practice Address - Phone:760-341-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty