Provider Demographics
NPI:1942736400
Name:ELITE THERAPY GROUP, INC
Entity Type:Organization
Organization Name:ELITE THERAPY GROUP, INC
Other - Org Name:ELITE MEDICAL WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-703-2625
Mailing Address - Street 1:4505 WEST FLAGLER STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:786-703-2625
Mailing Address - Fax:786-703-2609
Practice Address - Street 1:4505 WEST FLAGLER STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:786-703-2625
Practice Address - Fax:786-703-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty