Healthcare Provider Details

I. General information

NPI: 1396395679
Provider Name (Legal Business Name): ELITE CORE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13595 SW 134TH AVE STE 107
MIAMI FL
33186-4579
US

IV. Provider business mailing address

13595 SW 134TH AVE STE 107
MIAMI FL
33186-4579
US

V. Phone/Fax

Practice location:
  • Phone: 786-592-1190
  • Fax: 786-732-2955
Mailing address:
  • Phone: 786-592-1190
  • Fax: 786-732-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON ALPHONSO ELMORE
Title or Position: MGRM/ CEO
Credential: DPT
Phone: 803-378-6295