Provider Demographics
NPI:1588840680
Name:ELITE ORTHOPEDIC PHYSICAL THERAPY, APC
Entity Type:Organization
Organization Name:ELITE ORTHOPEDIC PHYSICAL THERAPY, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-735-8950
Mailing Address - Street 1:6000 DALE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-8401
Mailing Address - Country:US
Mailing Address - Phone:714-735-8950
Mailing Address - Fax:
Practice Address - Street 1:6000 DALE ST STE 104
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-8401
Practice Address - Country:US
Practice Address - Phone:714-735-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy