Provider Demographics
NPI:1891398129
Name:ELITE THERAPY LLC
Entity type:Organization
Organization Name:ELITE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JALISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:662-336-1504
Mailing Address - Street 1:140 FIORANELLI DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7313
Mailing Address - Country:US
Mailing Address - Phone:662-336-1504
Mailing Address - Fax:
Practice Address - Street 1:140 FIORANELLI DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7313
Practice Address - Country:US
Practice Address - Phone:662-336-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty