Provider Demographics
NPI:1114598604
Name:ELITE PHYSIO LLC
Entity Type:Organization
Organization Name:ELITE PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CABERWAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:904-347-4755
Mailing Address - Street 1:6 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9396
Mailing Address - Country:US
Mailing Address - Phone:904-347-4755
Mailing Address - Fax:
Practice Address - Street 1:2066 JUNIPER LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8919
Practice Address - Country:US
Practice Address - Phone:910-315-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy