Provider Demographics
NPI:1992432231
Name:ELITE THERAPY AND WELLNESS PSL LLC
Entity type:Organization
Organization Name:ELITE THERAPY AND WELLNESS PSL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-320-9302
Mailing Address - Street 1:2151 S ALTERNATE A1A STE 650
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4097
Mailing Address - Country:US
Mailing Address - Phone:561-320-9302
Mailing Address - Fax:561-320-9305
Practice Address - Street 1:5483 NW SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3444
Practice Address - Country:US
Practice Address - Phone:561-320-9302
Practice Address - Fax:561-320-9305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE THERAPY AND WELLNESS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty