Healthcare Provider Details

I. General information

NPI: 1386282366
Provider Name (Legal Business Name): ELITE MOVEMENT INITIATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 QUEENS BLVD # B11
FOREST HILLS NY
11375-4301
US

IV. Provider business mailing address

6155 98TH ST APT 16H
REGO PARK NY
11374-1439
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-1161
  • Fax: 201-591-7839
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BHAVIK SHETH
Title or Position: OWNER
Credential: PT, DPT
Phone: 718-308-5225