Healthcare Provider Details

I. General information

NPI: 1265158745
Provider Name (Legal Business Name): ELITE REHAB AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSINESS DEPOT RD
RINGGOLD GA
30736-1160
US

IV. Provider business mailing address

43 BROWNING DR
ROSSVILLE GA
30741-3370
US

V. Phone/Fax

Practice location:
  • Phone: 423-212-3278
  • Fax: 706-995-6859
Mailing address:
  • Phone: 423-779-4536
  • Fax: 706-995-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLI GUTHRIE
Title or Position: PT
Credential: DPT
Phone: 423-779-4536