Provider Demographics
NPI:1952786956
Name:ELITE PHYSICAL THERAPY MANAGEMENT COMPANY, LLC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY MANAGEMENT COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-757-6133
Mailing Address - Street 1:9222 BURBANK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-8612
Mailing Address - Country:US
Mailing Address - Phone:225-757-6133
Mailing Address - Fax:225-757-6174
Practice Address - Street 1:9222 BURBANK DR
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-8612
Practice Address - Country:US
Practice Address - Phone:225-757-6133
Practice Address - Fax:225-757-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty