Provider Demographics
NPI:1306536198
Name:ELITE KITSAP PERFORMANCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ELITE KITSAP PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:R
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-405-5795
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325-0296
Mailing Address - Country:US
Mailing Address - Phone:315-405-5795
Mailing Address - Fax:
Practice Address - Street 1:5686 NE MINDER RD STE 104
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-5809
Practice Address - Country:US
Practice Address - Phone:315-405-5795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty