Provider Demographics
NPI:1417417163
Name:ELITE PERFORMANCE INSTITUTE LLC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, SCS
Authorized Official - Phone:434-964-6952
Mailing Address - Street 1:19719 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1443
Mailing Address - Country:US
Mailing Address - Phone:434-964-6952
Mailing Address - Fax:
Practice Address - Street 1:19719 LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1443
Practice Address - Country:US
Practice Address - Phone:434-964-6952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty