Healthcare Provider Details

I. General information

NPI: 1427965383
Provider Name (Legal Business Name): ELITE PERFORMANCE AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N 14TH AVE STE S-1
DODGE CITY KS
67801-3461
US

IV. Provider business mailing address

1701 N 14TH AVE STE S1
DODGE CITY KS
67801-3461
US

V. Phone/Fax

Practice location:
  • Phone: 316-250-6248
  • Fax:
Mailing address:
  • Phone: 316-250-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AARON MAX EUGENE STAPLETON
Title or Position: CO-OWNER
Credential: DPT
Phone: 620-430-6980