Healthcare Provider Details

I. General information

NPI: 1154600716
Provider Name (Legal Business Name): ELITE THERAPEUTIC SPECIALISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 CORPUS CHRISTI ST
LAREDO TX
78040-5208
US

IV. Provider business mailing address

1020 CORPUS CHRISTI ST
LAREDO TX
78040-5208
US

V. Phone/Fax

Practice location:
  • Phone: 956-723-5700
  • Fax: 956-723-5706
Mailing address:
  • Phone: 956-723-5700
  • Fax: 956-723-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELISA SUSANNA DRUKER
Title or Position: OWNER/ADMINISTRATOR
Credential: MA,CCC-SLP
Phone: 956-723-5700