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General NPI Number Information
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NPI Number | 1073797924
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Entity Type | Organization
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Legal Business Name | ELITE PHYSICAL AND OCCUPATIONAL THERAPY PLLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 7309 MYRTLE AVE LOWER LEVEL
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City | GLENDALE
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State | NY
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Zip | 11385-7431
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Country | US
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Telephone | 718-381-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 7309 MYRTLE AVE LOWER LEVEL
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City | GLENDALE
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State | NY
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Zip | 11385-7431
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Country | US
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Telephone | 718-381-3555
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. FOTIS TSOLIS
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Credential | B.S., PT
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Telephone | 718-381-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 014696
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 021328
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License Number State | NY
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