Provider Demographics
NPI:1114692597
Name:ELITE ALLIANCE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ELITE ALLIANCE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FASANYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT, CSOMT
Authorized Official - Phone:469-531-9697
Mailing Address - Street 1:4201 POPPY HILL CT
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-6496
Mailing Address - Country:US
Mailing Address - Phone:469-531-9697
Mailing Address - Fax:
Practice Address - Street 1:2629 N STEMMONS FWY STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2115
Practice Address - Country:US
Practice Address - Phone:469-531-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty