Provider Demographics
NPI:1063787737
Name:ELITE PT LLC
Entity type:Organization
Organization Name:ELITE PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-226-2691
Mailing Address - Street 1:1 GRENOBLE PL
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-2847
Mailing Address - Country:US
Mailing Address - Phone:302-381-8348
Mailing Address - Fax:302-226-2692
Practice Address - Street 1:100 FITNESS WAY
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2423
Practice Address - Country:US
Practice Address - Phone:302-234-1030
Practice Address - Fax:302-234-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100006752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02656Medicare PIN