Provider Demographics
NPI:1659500296
Name:STERLING THERAPY PROVIDER, LLC
Entity Type:Organization
Organization Name:STERLING THERAPY PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLLY ELACO
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELACO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:313-729-0799
Mailing Address - Street 1:38765 MOUND RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3209
Mailing Address - Country:US
Mailing Address - Phone:586-274-0750
Mailing Address - Fax:586-274-0704
Practice Address - Street 1:38765 MOUND RD
Practice Address - Street 2:STE. 101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3209
Practice Address - Country:US
Practice Address - Phone:586-274-0750
Practice Address - Fax:586-274-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011330261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy