Provider Demographics
NPI:1235237637
Name:ELDERFIT PHYSICAL THERAPY AND CONSULTING INC.
Entity Type:Organization
Organization Name:ELDERFIT PHYSICAL THERAPY AND CONSULTING INC.
Other - Org Name:IHHOME REHAB NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-614-1923
Mailing Address - Street 1:2002 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6921
Mailing Address - Country:US
Mailing Address - Phone:919-614-1923
Mailing Address - Fax:
Practice Address - Street 1:2002 BARTLETT CIR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-6921
Practice Address - Country:US
Practice Address - Phone:919-614-1923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016MTOtherBCBS
NC2504061Medicare PIN