Provider Demographics
NPI:1770743023
Name:PT ELITE, INC.
Entity type:Organization
Organization Name:PT ELITE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:TONKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-253-8285
Mailing Address - Street 1:222 NE PARK PLAZA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5895
Mailing Address - Country:US
Mailing Address - Phone:360-253-8285
Mailing Address - Fax:
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-253-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7335261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR508460000OtherREGENCE BCBS
WAO9I009OtherREGENCE BCBS
WA7142904Medicaid
WA0236747OtherWASHINGTON LABOR DEPT
OR508460000OtherREGENCE BCBS