Provider Demographics
NPI:1811302292
Name:ELITE CARE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELITE CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALEA
Authorized Official - Middle Name:ACAP
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CKTP
Authorized Official - Phone:410-867-1517
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:CHURCHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20733-0355
Mailing Address - Country:US
Mailing Address - Phone:410-867-1517
Mailing Address - Fax:240-244-0601
Practice Address - Street 1:5950 DEALE CHURCHTON RD
Practice Address - Street 2:
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751-9730
Practice Address - Country:US
Practice Address - Phone:410-867-1517
Practice Address - Fax:240-244-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23487261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188002100Medicaid
2790106ZMZTMedicare PIN