Provider Demographics
NPI:1841481736
Name:ELITE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:864-233-5128
Mailing Address - Street 1:1011 GROVE RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4660
Mailing Address - Country:US
Mailing Address - Phone:864-233-5128
Mailing Address - Fax:864-271-2599
Practice Address - Street 1:30 RUSHMORE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1255
Practice Address - Country:US
Practice Address - Phone:864-233-5128
Practice Address - Fax:864-271-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT4585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8374Medicare PIN