Provider Demographics
NPI:1063684041
Name:ELITE PT LLC
Entity Type:Organization
Organization Name:ELITE PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:302-381-8348
Mailing Address - Street 1:910 FOULK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3158
Mailing Address - Country:US
Mailing Address - Phone:302-477-1536
Mailing Address - Fax:302-477-1564
Practice Address - Street 1:910 FOULK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3158
Practice Address - Country:US
Practice Address - Phone:302-477-1536
Practice Address - Fax:302-477-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000741225100000X
DEJ10000682225100000X
DEJ10000675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG20656Medicare PIN