Healthcare Provider Details

I. General information

NPI: 1932386448
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30941 MILL LANE SUITE D
DAPHNE AL
36526
US

IV. Provider business mailing address

PO BOX 7627
MOBILE AL
36670-0627
US

V. Phone/Fax

Practice location:
  • Phone: 251-533-3275
  • Fax:
Mailing address:
  • Phone: 251-625-2170
  • Fax: 251-625-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberPTH4377
License Number StateAL

VIII. Authorized Official

Name: MRS. AMBERLY C MASON
Title or Position: OWNER
Credential: PT
Phone: 251-425-2170