Provider Demographics
NPI:1396534632
Name:GOLFERS IN MOTION GOLF PERFORMANCE AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:GOLFERS IN MOTION GOLF PERFORMANCE AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEFINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-383-7960
Mailing Address - Street 1:5900 BALCONES DR STE 9020
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:737-383-7960
Mailing Address - Fax:
Practice Address - Street 1:3301 SHELL RD # 105
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2253
Practice Address - Country:US
Practice Address - Phone:737-383-7960
Practice Address - Fax:512-309-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty