Provider Demographics
NPI:1336394311
Name:ELITE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPT
Authorized Official - Prefix:
Authorized Official - First Name:MARGEAUX
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:740-275-6690
Mailing Address - Street 1:193 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-4205
Mailing Address - Country:US
Mailing Address - Phone:740-266-6855
Mailing Address - Fax:740-275-4182
Practice Address - Street 1:ELITE PHYSICAL THERAPY, LLC
Practice Address - Street 2:875 MAIN STREET
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953
Practice Address - Country:US
Practice Address - Phone:740-266-6855
Practice Address - Fax:740-275-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9381091Medicare PIN
PA183250Medicare PIN