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General NPI Number Information
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NPI Number | 1164722716
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 248 N MAIN ST SUITE 2
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City | SAINT ALBANS
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State | VT
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Zip | 05478-1554
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Country | US
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Telephone | 802-782-8547
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Fax |
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Provider Business Mailing Address
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Address Line | 248 N MAIN ST SUITE 2
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City | SAINT ALBANS
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State | VT
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Zip | 05478-1554
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Country | US
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Telephone | 802-782-8547
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE LYNN TATRO
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Credential | MSPT
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Telephone | 802-393-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0400003460
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License Number State | VT
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