Provider Demographics
NPI:1255567236
Name:ELITE PHYSICAL THERAPY AND HEALTH, LLC
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ANGUS
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-678-2155
Mailing Address - Street 1:1255 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1832
Mailing Address - Country:US
Mailing Address - Phone:208-678-2155
Mailing Address - Fax:208-678-2153
Practice Address - Street 1:1255 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1832
Practice Address - Country:US
Practice Address - Phone:208-678-2155
Practice Address - Fax:208-678-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2031261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy