Provider Demographics
NPI:1306207915
Name:ELITE ATHLETIC THERAPY, PLLC
Entity type:Organization
Organization Name:ELITE ATHLETIC THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CULLEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NIGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-609-0771
Mailing Address - Street 1:4201 BEE CAVES RD # 106
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6465
Mailing Address - Country:US
Mailing Address - Phone:303-817-2290
Mailing Address - Fax:888-854-2849
Practice Address - Street 1:4201 BEE CAVES RD # 106
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:303-817-2290
Practice Address - Fax:888-854-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1175083261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty