Provider Demographics
NPI:1639294481
Name:ELITE PHYSICAL THERAPY & FITNESS, PSC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY & FITNESS, PSC
Other - Org Name:ELITE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:270-756-5007
Mailing Address - Street 1:221 BALLPARK RD
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-4861
Mailing Address - Country:US
Mailing Address - Phone:270-756-5007
Mailing Address - Fax:270-756-5004
Practice Address - Street 1:221 BALLPARK RD
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-4861
Practice Address - Country:US
Practice Address - Phone:270-756-5007
Practice Address - Fax:270-756-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00320Medicare PIN