Healthcare Provider Details

I. General information

NPI: 1336394311
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 09/13/2023
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELITE PHYSICAL THERAPY, LLC 875 MAIN STREET
WINTERSVILLE OH
43953
US

IV. Provider business mailing address

193 SKYVIEW DR
WINTERSVILLE OH
43953-4205
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-6855
  • Fax: 740-275-4182
Mailing address:
  • Phone: 740-266-6855
  • Fax: 740-275-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARGEAUX L MALLAS
Title or Position: OWNER/DPT
Credential: DPT
Phone: 740-275-6690