Provider Demographics
NPI:1669804530
Name:ELITE THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:ELITE THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-920-8415
Mailing Address - Street 1:434 WYNDALE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-9057
Mailing Address - Country:US
Mailing Address - Phone:304-920-8415
Mailing Address - Fax:
Practice Address - Street 1:313 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-431-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy