Provider Demographics
NPI:1427577378
Name:ELITE PERFORMANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELITE PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-313-7687
Mailing Address - Street 1:4365 E PECOS RD STE 125 126
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7875
Mailing Address - Country:US
Mailing Address - Phone:208-313-7687
Mailing Address - Fax:
Practice Address - Street 1:4365 E PECOS RD STE 125126
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7875
Practice Address - Country:US
Practice Address - Phone:208-313-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9953261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy