Provider Demographics
NPI:1871647024
Name:ELITE PHYSICAL THERAPY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST- DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:202-965-8901
Mailing Address - Street 1:2233 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4104
Mailing Address - Country:US
Mailing Address - Phone:202-965-8901
Mailing Address - Fax:202-965-8903
Practice Address - Street 1:2233 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 311
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4104
Practice Address - Country:US
Practice Address - Phone:202-965-8901
Practice Address - Fax:202-965-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2705225100000X
DC1192025622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK3250001OtherBCBS PROVIDER NUMBER
DCG02085E01Medicare ID - Type UnspecifiedPROVIDER NUMBER