Provider Demographics
NPI:1477969574
Name:ELITE PHYSIQUE PERFORMANCE TRAINING, LLC.
Entity Type:Organization
Organization Name:ELITE PHYSIQUE PERFORMANCE TRAINING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-377-7539
Mailing Address - Street 1:2325 CORTINA LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8933
Mailing Address - Country:US
Mailing Address - Phone:505-377-7539
Mailing Address - Fax:
Practice Address - Street 1:5740 NIGHT WHISPER RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1575
Practice Address - Country:US
Practice Address - Phone:505-377-7539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11423NMPFT174400000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty