Healthcare Provider Details

I. General information

NPI: 1013452176
Provider Name (Legal Business Name): ELITE PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SOUTH AVE W
WESTFIELD NJ
07090-1415
US

IV. Provider business mailing address

918 SOUTH AVE W
WESTFIELD NJ
07090-1415
US

V. Phone/Fax

Practice location:
  • Phone: 855-633-3786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01103700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01105400
License Number StateNJ

VIII. Authorized Official

Name: THAO TRAN
Title or Position: OWNER
Credential: PT
Phone: 855-633-3786