Provider Demographics
NPI:1942787304
Name:GOLF REHAB SPECIALISTS, LLC
Entity Type:Organization
Organization Name:GOLF REHAB SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TOWARD
Authorized Official - Suffix:II
Authorized Official - Credentials:MPT
Authorized Official - Phone:561-202-7047
Mailing Address - Street 1:6120 WINDING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3739
Mailing Address - Country:US
Mailing Address - Phone:561-202-7047
Mailing Address - Fax:
Practice Address - Street 1:6120 WINDING LAKE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3739
Practice Address - Country:US
Practice Address - Phone:561-202-7047
Practice Address - Fax:561-972-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889096000Medicaid