Provider Demographics
NPI:1558151464
Name:FIT ELITE PERFORMANCE GROUP
Entity type:Organization
Organization Name:FIT ELITE PERFORMANCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:L
Authorized Official - Last Name:COURSEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-704-1254
Mailing Address - Street 1:2520 HARVARD AVE # 2B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1172
Mailing Address - Country:US
Mailing Address - Phone:504-704-1254
Mailing Address - Fax:866-572-0930
Practice Address - Street 1:2520 HARVARD AVE STE 2B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1172
Practice Address - Country:US
Practice Address - Phone:504-704-1254
Practice Address - Fax:866-572-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service