Provider Demographics
NPI:1164136685
Name:ELICENT OSTEOPRACTIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ELICENT OSTEOPRACTIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NNABUIKEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANABA
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPISTS
Authorized Official - Phone:773-865-1522
Mailing Address - Street 1:1150 W 24TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8368
Mailing Address - Country:US
Mailing Address - Phone:773-865-1522
Mailing Address - Fax:
Practice Address - Street 1:1150 W 24TH ST STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:773-865-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty