Provider Demographics
NPI:1417405952
Name:ELITE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ELITE THERAPY SERVICES LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTERS - DRAPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC
Authorized Official - Phone:801-571-6600
Mailing Address - Street 1:12198 S STATE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9647
Mailing Address - Country:US
Mailing Address - Phone:801-571-6600
Mailing Address - Fax:801-571-7646
Practice Address - Street 1:12198 S STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9647
Practice Address - Country:US
Practice Address - Phone:801-571-6600
Practice Address - Fax:801-571-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5401450-2401225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005560704Medicare PIN
UTU000096433Medicare UPIN