Provider Demographics
NPI:1184953390
Name:ELITE HEALTH AND FITNESS
Entity type:Organization
Organization Name:ELITE HEALTH AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:781-297-0979
Mailing Address - Street 1:1519 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4415
Mailing Address - Country:US
Mailing Address - Phone:781-297-0979
Mailing Address - Fax:
Practice Address - Street 1:1519 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4415
Practice Address - Country:US
Practice Address - Phone:781-297-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3992261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy