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General NPI Number Information
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NPI Number | 1073726386
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Entity Type | Organization
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Legal Business Name | ELITE AMBULATORY SERVICES LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1690 SWEETLAND ST
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City | NOKOMIS
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State | FL
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Zip | 34275-1634
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Country | US
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Telephone | 941-544-7512
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 SWEETLAND ST
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City | NOKOMIS
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State | FL
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Zip | 34275-1634
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Country | US
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Telephone | 941-544-7512
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH I TRIBIT
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Credential | PT
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Telephone | 941-544-7512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 19775
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License Number State | FL
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