Provider Demographics
NPI:1679071302
Name:ELITE THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:ELITE THERAPY AND WELLNESS
Other - Org Name:HOLLI LILLARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-869-7220
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:IMBODEN
Mailing Address - State:AR
Mailing Address - Zip Code:72434-0334
Mailing Address - Country:US
Mailing Address - Phone:870-869-2770
Mailing Address - Fax:870-869-7221
Practice Address - Street 1:5552 US HWY 63
Practice Address - Street 2:SUITE B
Practice Address - City:IMBODEN
Practice Address - State:AR
Practice Address - Zip Code:72434
Practice Address - Country:US
Practice Address - Phone:870-869-2770
Practice Address - Fax:870-869-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2712225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty