Provider Demographics
NPI:1073890570
Name:ELITE PERFORMANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAWELEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-324-0092
Mailing Address - Street 1:710 LEONA ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2349
Mailing Address - Country:US
Mailing Address - Phone:440-324-0092
Mailing Address - Fax:440-324-0093
Practice Address - Street 1:710 LEONA ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2349
Practice Address - Country:US
Practice Address - Phone:440-324-0092
Practice Address - Fax:440-324-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH93382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty