Provider Demographics
NPI:1639523798
Name:ELITE PHYSICAL THERAPY AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:334-770-0649
Mailing Address - Street 1:1404 S BRUNDIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3129
Mailing Address - Country:US
Mailing Address - Phone:334-770-0649
Mailing Address - Fax:334-770-0650
Practice Address - Street 1:1404 S BRUNDIDGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3129
Practice Address - Country:US
Practice Address - Phone:334-770-0649
Practice Address - Fax:334-770-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4195305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization