Provider Demographics
NPI:1972812808
Name:ELITE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:STOOKSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-257-8700
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-1787
Mailing Address - Country:US
Mailing Address - Phone:865-257-8700
Mailing Address - Fax:
Practice Address - Street 1:7545 BARNETT WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3565
Practice Address - Country:US
Practice Address - Phone:865-257-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty