Provider Demographics
NPI:1659605434
Name:ELITE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:ATC,PT
Authorized Official - Phone:512-302-5551
Mailing Address - Street 1:1515 W 35TH ST
Mailing Address - Street 2:BLDG E
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1434
Mailing Address - Country:US
Mailing Address - Phone:512-302-5551
Mailing Address - Fax:512-302-5553
Practice Address - Street 1:1515 W 35TH ST
Practice Address - Street 2:BLDG E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1434
Practice Address - Country:US
Practice Address - Phone:512-302-5551
Practice Address - Fax:512-302-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6559400002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty