Provider Demographics
NPI:1184890741
Name:ELITE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-699-2273
Mailing Address - Street 1:3415 HAMILTON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3953
Mailing Address - Country:US
Mailing Address - Phone:301-699-2273
Mailing Address - Fax:301-699-0693
Practice Address - Street 1:3415 HAMILTON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3953
Practice Address - Country:US
Practice Address - Phone:301-699-2273
Practice Address - Fax:301-699-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20199261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy