Provider Demographics
NPI:1396053039
Name:ELITE REHAB & FITNESS
Entity type:Organization
Organization Name:ELITE REHAB & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCMACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:740-646-5652
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0107
Mailing Address - Country:US
Mailing Address - Phone:740-532-0770
Mailing Address - Fax:
Practice Address - Street 1:202 PARK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1548
Practice Address - Country:US
Practice Address - Phone:740-532-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty