Provider Demographics
NPI:1275071169
Name:ELITE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ABHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:PT/MS
Authorized Official - Phone:209-985-3495
Mailing Address - Street 1:201 E ORANGEBURG AVE
Mailing Address - Street 2:STE E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5355
Mailing Address - Country:US
Mailing Address - Phone:209-985-3495
Mailing Address - Fax:
Practice Address - Street 1:201 E ORANGEBURG AVE
Practice Address - Street 2:STE E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5355
Practice Address - Country:US
Practice Address - Phone:209-985-3495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29454261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy