Provider Demographics
NPI:1417195173
Name:ELEMENTS FITNESS AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ELEMENTS FITNESS AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:202-333-5252
Mailing Address - Street 1:2233 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4104
Mailing Address - Country:US
Mailing Address - Phone:202-333-5252
Mailing Address - Fax:202-333-5252
Practice Address - Street 1:2233 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4104
Practice Address - Country:US
Practice Address - Phone:202-333-5252
Practice Address - Fax:202-333-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870544261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy