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General NPI Number Information
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NPI Number | 1417417163
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Entity Type | Organization
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Legal Business Name | ELITE PERFORMANCE INSTITUTE LLC
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 19719 LEITERSBURG PIKE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1443
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Country | US
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Telephone | 434-964-6952
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Fax |
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Provider Business Mailing Address
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Address Line | 19719 LEITERSBURG PIKE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1443
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Country | US
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Telephone | 434-964-6952
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Fax |
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Authorized Official
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Title or Position | CO-OWNER / PHYSICAL THERAPIST
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Name | DR. JOHN PUGH
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Credential | DPT, ATC, SCS
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Telephone | 434-964-6952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical 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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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