Provider Demographics
NPI:1396395679
Name:ELITE CORE THERAPY, LLC
Entity Type:Organization
Organization Name:ELITE CORE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ALPHONSO
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:803-378-6295
Mailing Address - Street 1:13595 SW 134TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4579
Mailing Address - Country:US
Mailing Address - Phone:786-592-1190
Mailing Address - Fax:786-732-2955
Practice Address - Street 1:13595 SW 134TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4579
Practice Address - Country:US
Practice Address - Phone:786-592-1190
Practice Address - Fax:786-732-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty