Provider Demographics
NPI:1831645480
Name:ELITE PHYSICAL THERAPY & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANDARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-617-8000
Mailing Address - Street 1:436 ROUTE 79
Mailing Address - Street 2:SUITE 21
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-617-8000
Mailing Address - Fax:
Practice Address - Street 1:436 ROUTE 79
Practice Address - Street 2:SUITE 21
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-617-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy