Provider Demographics
NPI:1013940634
Name:ELITE REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:ELITE REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-681-9108
Mailing Address - Street 1:5152 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2526
Mailing Address - Country:US
Mailing Address - Phone:805-681-9108
Mailing Address - Fax:805-681-9208
Practice Address - Street 1:5152 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2526
Practice Address - Country:US
Practice Address - Phone:805-681-9108
Practice Address - Fax:805-681-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT22203OtherPHYSICAL THERAPY
CAPT28354OtherPHYSICAL THERAPY
CAPT28126OtherPHYSICAL THERAPY
CAPT28528OtherPHYSICAL THERAPY