Healthcare Provider Details

I. General information

NPI: 1255670840
Provider Name (Legal Business Name): ELITE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2013
Last Update Date: 02/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 COUNTY ROAD C
DESHLER OH
43516-9758
US

IV. Provider business mailing address

3816 COUNTY ROAD C
DESHLER OH
43516-9758
US

V. Phone/Fax

Practice location:
  • Phone: 419-906-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL BOYER
Title or Position: OWNER
Credential: MPT
Phone: 419-906-1088