Provider Demographics
NPI:1659792836
Name:ELITE PHYSICAL THERAPY AND PILATES REHABILITATION PC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND PILATES REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BANCALE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:800-391-9477
Mailing Address - Street 1:2851 S AVENUE B STE 2402
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:800-391-9477
Mailing Address - Fax:
Practice Address - Street 1:2851 S AVENUE B STE 2402
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-276-4178
Practice Address - Fax:928-276-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-14
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10760A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy