MEDICARE: GOLF REHAB SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT19114	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942787304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLF REHAB SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	6120 WINDING LAKE DR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-3739
Country	:	US
Telephone Number	:	561-202-7047
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 WINDING LAKE DR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-3739
Country	:	US
Telephone Number	:	561-202-7047
Fax Number	:	561-972-7066

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. TIMOTHY ROBERT TOWARD II
Credential	:	MPT
Telephone Number	:	561-202-7047

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	03/22/2019

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