Provider Demographics
NPI:1306493119
Name:ELITE THERAPY CORP
Entity type:Organization
Organization Name:ELITE THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-325-8860
Mailing Address - Street 1:12647 TIMBER CREST DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8639
Mailing Address - Country:US
Mailing Address - Phone:317-325-8860
Mailing Address - Fax:
Practice Address - Street 1:250 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5927
Practice Address - Country:US
Practice Address - Phone:317-325-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation