Provider Demographics
NPI:1912121575
Name:ELITE REHABILITATION PC
Entity Type:Organization
Organization Name:ELITE REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:BYERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-262-7644
Mailing Address - Street 1:104 S BINKLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8006
Mailing Address - Country:US
Mailing Address - Phone:907-262-7644
Mailing Address - Fax:907-262-6744
Practice Address - Street 1:104 S BINKLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8006
Practice Address - Country:US
Practice Address - Phone:907-262-7644
Practice Address - Fax:907-262-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1014261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health