Provider Demographics
NPI:1164770434
Name:ELITE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-408-9186
Mailing Address - Street 1:125 COMMERCE DR
Mailing Address - Street 2:STE G
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7336
Mailing Address - Country:US
Mailing Address - Phone:678-545-2530
Mailing Address - Fax:678-545-2531
Practice Address - Street 1:125 COMMERCE DR
Practice Address - Street 2:STE G
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7336
Practice Address - Country:US
Practice Address - Phone:678-545-2530
Practice Address - Fax:678-545-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty