Provider Demographics
NPI:1336458546
Name:ELITE PERFORMANCE, INC.
Entity Type:Organization
Organization Name:ELITE PERFORMANCE, INC.
Other - Org Name:ELITE PERFORMANCE PHYSICAL THERAPY & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-622-5493
Mailing Address - Street 1:PO BOX 4366
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4366
Mailing Address - Country:US
Mailing Address - Phone:956-622-5493
Mailing Address - Fax:956-720-0859
Practice Address - Street 1:602 KAMALI DR.
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3223
Practice Address - Country:US
Practice Address - Phone:956-622-5493
Practice Address - Fax:956-720-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB112929Medicare PIN