Provider Demographics
NPI:1730635087
Name:ELITE PHYSICAL THERAPY AND WELLNESS, INC.
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-616-3331
Mailing Address - Street 1:P.O BOX 194
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327
Mailing Address - Country:US
Mailing Address - Phone:601-635-4131
Mailing Address - Fax:
Practice Address - Street 1:135 7TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327
Practice Address - Country:US
Practice Address - Phone:601-635-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4343261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy