Provider Demographics
NPI:1881139889
Name:ELITE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:ELITE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:254-899-8255
Mailing Address - Street 1:220 WHISPERING OAKS
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-3507
Mailing Address - Country:US
Mailing Address - Phone:254-899-8255
Mailing Address - Fax:254-235-3408
Practice Address - Street 1:2901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1360
Practice Address - Country:US
Practice Address - Phone:254-899-8255
Practice Address - Fax:254-235-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation