Healthcare Provider Details

I. General information

NPI: 1871647024
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 WISCONSIN AVE NW SUITE 311
WASHINGTON DC
20007-4104
US

IV. Provider business mailing address

2233 WISCONSIN AVE NW SUITE 311
WASHINGTON DC
20007-4104
US

V. Phone/Fax

Practice location:
  • Phone: 202-965-8901
  • Fax: 202-965-8903
Mailing address:
  • Phone: 202-965-8901
  • Fax: 202-965-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number119202562
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2705
License Number StateDC

VIII. Authorized Official

Name: MS. TERRY ANN SNEED
Title or Position: PHYSICAL THERAPIST- DIRECTOR
Credential: P.T., A.T.C.
Phone: 202-965-8901