Healthcare Provider Details

I. General information

NPI: 1760576789
Provider Name (Legal Business Name): ELITE THERAPY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W KNAPP ST SUITE 4
RICE LAKE WI
54868
US

IV. Provider business mailing address

1801 W KNAPP ST SUITE 4
RICE LAKE WI
54868
US

V. Phone/Fax

Practice location:
  • Phone: 715-736-4384
  • Fax: 844-829-7001
Mailing address:
  • Phone: 715-736-4384
  • Fax: 844-829-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY L ECK
Title or Position: OWNER
Credential: PT
Phone: 715-736-4384