Healthcare Provider Details

I. General information

NPI: 1811482599
Provider Name (Legal Business Name): ELITE PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 KENNETT PIKE
WILMINGTON DE
19807-1813
US

IV. Provider business mailing address

4825 KENNETT PIKE
WILMINGTON DE
19807-1813
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 Code2251S0007X
TaxonomySports Physical Therapist
License NumberJ1-0000675
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ1-0000675
License Number StateDE

VIII. Authorized Official

Name: JOHN FRANKLIN KNARR
Title or Position: PRESIDENT
Credential: PT
Phone: 302-381-8348