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General NPI Number Information
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NPI Number | 1396534632
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Entity Type | Organization
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Legal Business Name | GOLFERS IN MOTION GOLF PERFORMANCE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 3301 SHELL RD # 105
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City | GEORGETOWN
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State | TX
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Zip | 78628-2253
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Country | US
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Telephone | 737-383-7960
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Fax | 512-309-7032
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 9020
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 737-383-7960
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JOSEFINO MACTAL
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Credential |
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Telephone | 737-383-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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