Provider Demographics
NPI:1649590035
Name:ELITE SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELITE SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MSPT
Authorized Official - Phone:732-544-0011
Mailing Address - Street 1:1540 W PARK AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3191
Mailing Address - Country:US
Mailing Address - Phone:732-544-0011
Mailing Address - Fax:732-544-1115
Practice Address - Street 1:1540 W PARK AVE
Practice Address - Street 2:STE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712-3191
Practice Address - Country:US
Practice Address - Phone:732-544-0011
Practice Address - Fax:732-544-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty