Organization
BACKTOGOLF PERFORMANCE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M. JAY PLATT P.T. (PRESIDENT)
(512) 371-7687
Entity
Organization
Contact information
Practice address
7401 STATE HIGHWAY 45, AUSTIN, TX 78739-1901
(512) 371-7687
(512) 371-7601
Mailing address
11318 ADEN CT, AUSTIN, TX 78739-1589
(512) 371-7687
(512) 371-7601
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
1029148
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089GJ
BCBS GROUP NUMBER
TX
Enumeration date
06/12/2007
Last updated
08/22/2020
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