Healthcare Provider Details

I. General information

NPI: 1417405952
Provider Name (Legal Business Name): ELITE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12198 S STATE ST SUITE 3
DRAPER UT
84020-9647
US

IV. Provider business mailing address

12198 S STATE ST SUITE 3
DRAPER UT
84020-9647
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-6600
  • Fax: 801-571-7646
Mailing address:
  • Phone: 801-571-6600
  • Fax: 801-571-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5401450-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5401450-2401
License Number StateUT

VIII. Authorized Official

Name: STEVEN E ROBBINS
Title or Position: OWNER
Credential: MSPT, ATC
Phone: 801-571-6600