Provider Demographics
NPI:1972880243
Name:ELITE PERFORMANCE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:412-788-4626
Mailing Address - Street 1:7051 STEUBENVILLE PIKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-1509
Mailing Address - Country:US
Mailing Address - Phone:412-788-4626
Mailing Address - Fax:412-788-4335
Practice Address - Street 1:7051 STEUBENVILLE PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-3318
Practice Address - Country:US
Practice Address - Phone:412-788-4626
Practice Address - Fax:412-788-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-006821L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty