Healthcare Provider Details

I. General information

NPI: 1508918483
Provider Name (Legal Business Name): ELITE PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 DULANEY VALLEY RD
LUTHERVILLE MD
21093-2819
US

IV. Provider business mailing address

23924 SUNNY COVE CT VILLAGES AT HERRING CREEK
LEWES DE
19958-5695
US

V. Phone/Fax

Practice location:
  • Phone: 443-901-1938
  • Fax:
Mailing address:
  • Phone: 302-947-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN F. KNARR
Title or Position: PARTNER
Credential: PT
Phone: 302-381-8348