Provider Demographics
NPI:1336475664
Name:ELITE HEALTH SERVICES
Entity Type:Organization
Organization Name:ELITE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-983-5748
Mailing Address - Street 1:1445 E PUTNAM AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1379
Mailing Address - Country:US
Mailing Address - Phone:203-983-5748
Mailing Address - Fax:203-869-4420
Practice Address - Street 1:76 VALLEY RD
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2533
Practice Address - Country:US
Practice Address - Phone:203-983-5748
Practice Address - Fax:203-869-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty