Healthcare Provider Details

I. General information

NPI: 1851072466
Provider Name (Legal Business Name): FLORIDA GOLF PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BAYTREE DR
ROTONDA WEST FL
33947-3821
US

IV. Provider business mailing address

203 BAYTREE DR
ROTONDA WEST FL
33947-3821
US

V. Phone/Fax

Practice location:
  • Phone: 941-999-1129
  • Fax:
Mailing address:
  • Phone: 941-999-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ALEXANDER BURHOE
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 941-999-1129