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General NPI Number Information
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NPI Number | 1164770434
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 125 COMMERCE DR STE G
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7336
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Country | US
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Telephone | 678-545-2530
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Fax | 678-545-2531
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Provider Business Mailing Address
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Address Line | 125 COMMERCE DR STE G
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7336
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Country | US
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Telephone | 678-545-2530
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Fax | 678-545-2531
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Authorized Official
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Title or Position | OWNER
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Name | DR. YOLANDA WASHINGTON
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Credential | DPT
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Telephone | 404-408-9186
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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 | PT007563
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License Number State | GA
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