Provider Demographics
NPI:1992538904
Name:ELITE REHAB AND PERFORMANCE
Entity type:Organization
Organization Name:ELITE REHAB AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:404-229-9118
Mailing Address - Street 1:3025 NC HIGHWAY 24
Mailing Address - Street 2:UNIT 3
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570
Mailing Address - Country:US
Mailing Address - Phone:252-222-0424
Mailing Address - Fax:
Practice Address - Street 1:3025 NC HIGHWAY 24
Practice Address - Street 2:UNIT 3
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570
Practice Address - Country:US
Practice Address - Phone:252-222-0424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy