Provider Demographics
NPI:1427343383
Name:ELITE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:231-590-1364
Mailing Address - Street 1:4177 VILLAGE PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7237
Mailing Address - Country:US
Mailing Address - Phone:231-590-1364
Mailing Address - Fax:
Practice Address - Street 1:4177 VILLAGE PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7237
Practice Address - Country:US
Practice Address - Phone:231-590-1364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009481261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy