Healthcare Provider Details

I. General information

NPI: 1811302292
Provider Name (Legal Business Name): ELITE CARE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 DEALE CHURCHTON RD
DEALE MD
20751-9730
US

IV. Provider business mailing address

PO BOX 355
CHURCHTON MD
20733-0355
US

V. Phone/Fax

Practice location:
  • Phone: 410-867-1517
  • Fax: 240-244-0601
Mailing address:
  • Phone: 410-867-1517
  • Fax: 240-244-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number23487
License Number StateMD

VIII. Authorized Official

Name: MRS. ROSALEA ACAP KNIGHT
Title or Position: OWNER
Credential: DPT, ATC, CKTP
Phone: 410-867-1517