Provider Demographics
NPI:1811357163
Name:ELITE PERFORMANCE AND THERAPY
Entity type:Organization
Organization Name:ELITE PERFORMANCE AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KODESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:206-999-6331
Mailing Address - Street 1:284 CENTRAL WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6104
Mailing Address - Country:US
Mailing Address - Phone:425-605-1288
Mailing Address - Fax:425-605-1288
Practice Address - Street 1:284 CENTRAL WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6104
Practice Address - Country:US
Practice Address - Phone:425-605-1288
Practice Address - Fax:425-605-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000087312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty