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General NPI Number Information
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NPI Number | 1184953390
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH AND FITNESS
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 1519 CENTRAL ST
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City | STOUGHTON
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State | MA
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Zip | 02072-4415
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Country | US
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Telephone | 781-297-0979
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 CENTRAL ST
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City | STOUGHTON
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State | MA
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Zip | 02072-4415
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Country | US
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Telephone | 781-297-0979
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. KEITH CALLANAN
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Credential | MSPT
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Telephone | 781-297-0979
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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 | 3992
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License Number State | MA
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