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General NPI Number Information
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NPI Number | 1235693300
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY CORP
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 2312 S DIXON RD STE 250
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City | KOKOMO
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State | IN
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Zip | 46902-6426
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Country | US
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Telephone | 765-459-7275
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Fax |
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Provider Business Mailing Address
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Address Line | 12647 TIMBER CREST DR
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City | CARMEL
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State | IN
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Zip | 46033-8639
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Country | US
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Telephone | 914-484-1731
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MELISSA DICKE
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Credential | PT, DPT
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Telephone | 914-484-1731
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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