Provider Demographics
NPI:1457940785
Name:TRANSFORMATION REHABILITATION, LLC
Entity Type:Organization
Organization Name:TRANSFORMATION REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:561-345-4857
Mailing Address - Street 1:10758 SUNSET RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4866
Mailing Address - Country:US
Mailing Address - Phone:561-345-4857
Mailing Address - Fax:
Practice Address - Street 1:10758 SUNSET RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4866
Practice Address - Country:US
Practice Address - Phone:561-345-4857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy