Healthcare Provider Details

I. General information

NPI: 1063684041
Provider Name (Legal Business Name): ELITE PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2008
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOULK RD SUITE 100
WILMINGTON DE
19803-3158
US

IV. Provider business mailing address

910 FOULK RD SUITE 100
WILMINGTON DE
19803-3158
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-1536
  • Fax: 302-477-1564
Mailing address:
  • Phone: 302-477-1536
  • Fax: 302-477-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10000682
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10000675
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10000741
License Number StateDE

VIII. Authorized Official

Name: MR. JOHN F KNARR
Title or Position: PARTNER
Credential: PT, ATC
Phone: 302-381-8348