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General NPI Number Information
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NPI Number | 1194067702
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Entity Type | Organization
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Legal Business Name | ELITE PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 19888 N 73RD AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-8904
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Country | US
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Telephone | 623-234-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 19888 N 73RD AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-8904
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Country | US
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Telephone | 623-234-3368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG BRECHLER
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Credential | PT
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Telephone | 623-234-3368
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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 | 7400
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License Number State | AZ
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