Provider Demographics
NPI:1811419864
Name:ELITE PT LLC
Entity type:Organization
Organization Name:ELITE PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-381-8348
Mailing Address - Street 1:1 GRENOBLE PL
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-2847
Mailing Address - Country:US
Mailing Address - Phone:302-226-2691
Mailing Address - Fax:302-226-2692
Practice Address - Street 1:707 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2546
Practice Address - Country:US
Practice Address - Phone:610-526-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE PT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100006752251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty