Provider Demographics
NPI:1508583386
Name:ELITE PHYSICAL THERAPY AND PERFORMANCE, PLLC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:586-484-5548
Mailing Address - Street 1:33487 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4253
Mailing Address - Country:US
Mailing Address - Phone:586-388-0016
Mailing Address - Fax:586-388-0015
Practice Address - Street 1:33487 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-4253
Practice Address - Country:US
Practice Address - Phone:586-484-5548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation