Healthcare Provider Details

I. General information

NPI: 1306207915
Provider Name (Legal Business Name): ELITE ATHLETIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BEE CAVES RD # 106
WEST LAKE HILLS TX
78746-6465
US

IV. Provider business mailing address

4201 BEE CAVES RD # 106
WEST LAKE HILLS TX
78746-6465
US

V. Phone/Fax

Practice location:
  • Phone: 303-817-2290
  • Fax: 888-854-2849
Mailing address:
  • Phone: 303-817-2290
  • Fax: 888-854-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1175083
License Number StateTX

VIII. Authorized Official

Name: CULLEN MICHAEL NIGRINI
Title or Position: OWNER
Credential: PT
Phone: 512-609-0771