Healthcare Provider Details

I. General information

NPI: 1699095042
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S NOVA RD STE 2
ORMOND BEACH FL
32174-0409
US

IV. Provider business mailing address

410 S NOVA RD STE 2
ORMOND BEACH FL
32174-0409
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-6114
  • Fax: 386-968-1938
Mailing address:
  • Phone: 386-675-6114
  • Fax: 386-968-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE SIGAFOOS
Title or Position: OWNER
Credential: PTA
Phone: 386-675-6114