Provider Demographics
NPI:1356687974
Name:ELITE THERAPY SERVICES
Entity Type:Organization
Organization Name:ELITE THERAPY SERVICES
Other - Org Name:ETCH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:II
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:931-815-3824
Mailing Address - Street 1:220 SNOW HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-7592
Mailing Address - Country:US
Mailing Address - Phone:931-815-3824
Mailing Address - Fax:
Practice Address - Street 1:220 SNOW HOLLOW LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-7592
Practice Address - Country:US
Practice Address - Phone:931-815-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy