Provider Demographics
NPI:1255660619
Name:ELITE PHYSICAL THERAPY & REHAB, INC.
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAJAKUMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUPPAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,MHA
Authorized Official - Phone:941-916-2313
Mailing Address - Street 1:PO BOX 494857
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4857
Mailing Address - Country:US
Mailing Address - Phone:941-916-2313
Mailing Address - Fax:941-206-7250
Practice Address - Street 1:1032 TAMIAMI TRL
Practice Address - Street 2:UNIT 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3802
Practice Address - Country:US
Practice Address - Phone:941-916-2313
Practice Address - Fax:941-206-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy