Provider Demographics
NPI:1760576789
Name:ELITE THERAPY INSTITUTE LLC
Entity Type:Organization
Organization Name:ELITE THERAPY INSTITUTE LLC
Other - Org Name:ET I WOUND HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-736-4384
Mailing Address - Street 1:1801 W KNAPP ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868
Mailing Address - Country:US
Mailing Address - Phone:715-736-4384
Mailing Address - Fax:844-829-7001
Practice Address - Street 1:1801 W KNAPP ST
Practice Address - Street 2:SUITE 4
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:715-736-4384
Practice Address - Fax:844-829-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies