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General NPI Number Information
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NPI Number | 1548683279
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Entity Type | Organization
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Legal Business Name | ELITE HEALTHCARE SOUTH DALLAS
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 4305 PINNACLE POINT DR. # 301
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City | DALLAS
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State | TX
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Zip | 75211
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Country | US
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Telephone | 214-337-2100
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Fax | 214-337-2108
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Provider Business Mailing Address
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Address Line | PO BOX 1752
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City | FRISCO
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State | TX
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Zip | 75034
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Country | US
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Telephone | 972-417-9922
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Fax | 972-417-9605
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Authorized Official
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Title or Position | COLLECTIONS COORD.
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Name | MRS. JEN LEE WHISLER-PARVIN
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Credential |
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Telephone | 972-417-9922
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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 | PT1107050
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | DC9745
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC9745
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC8314
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | DC8314
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License Number State | TX
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