Provider Demographics
NPI:1104926419
Name:ELITE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:704-333-1052
Mailing Address - Street 1:2630 E 7TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4318
Mailing Address - Country:US
Mailing Address - Phone:704-333-1052
Mailing Address - Fax:
Practice Address - Street 1:2630 E 7TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4318
Practice Address - Country:US
Practice Address - Phone:704-333-1052
Practice Address - Fax:704-333-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB853Medicare PIN