Healthcare Provider Details

I. General information

NPI: 1073797924
Provider Name (Legal Business Name): ELITE PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 MYRTLE AVE LOWER LEVEL
GLENDALE NY
11385-7431
US

IV. Provider business mailing address

7309 MYRTLE AVE LOWER LEVEL
GLENDALE NY
11385-7431
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-3555
  • Fax:
Mailing address:
  • Phone: 718-381-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021328
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number014696
License Number StateNY

VIII. Authorized Official

Name: MR. FOTIS TSOLIS
Title or Position: OWNER/DIRECTOR
Credential: B.S., PT
Phone: 718-381-3555