Healthcare Provider Details

I. General information

NPI: 1922363969
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 N MAIN ST
SHELBYVILLE TN
37160-2310
US

IV. Provider business mailing address

1116 N MAIN ST
SHELBYVILLE TN
37160-2310
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-0027
  • Fax: 931-684-0112
Mailing address:
  • Phone: 931-684-0027
  • Fax: 931-684-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number9262
License Number StateTN

VIII. Authorized Official

Name: MRS. MOLLY HILLHOUSE
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 931-684-0027