Provider Demographics
NPI:1790935401
Name:ELITE WELLNESS AND REHAB SERVICES LLC
Entity Type:Organization
Organization Name:ELITE WELLNESS AND REHAB SERVICES LLC
Other - Org Name:THE MOVEMENT AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-331-9356
Mailing Address - Street 1:7135 NW 11TH PL
Mailing Address - Street 2:SUITE B3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3143
Mailing Address - Country:US
Mailing Address - Phone:352-331-9356
Mailing Address - Fax:352-331-9357
Practice Address - Street 1:7135 NW 11TH PL
Practice Address - Street 2:SUITE B3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3143
Practice Address - Country:US
Practice Address - Phone:352-331-9356
Practice Address - Fax:352-331-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP893AOtherPTAN