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General NPI Number Information
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NPI Number | 1790935401
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Entity Type | Organization
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Legal Business Name | ELITE WELLNESS AND REHAB SERVICES LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 7135 NW 11TH PL SUITE B3
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City | GAINESVILLE
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State | FL
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Zip | 32605-3143
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Country | US
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Telephone | 352-331-9356
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Fax | 352-331-9357
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Provider Business Mailing Address
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Address Line | 7135 NW 11TH PL SUITE B3
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City | GAINESVILLE
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State | FL
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Zip | 32605-3143
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Country | US
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Telephone | 352-331-9356
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Fax | 352-331-9357
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATE M HUNT
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Credential | PT
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Telephone | 352-331-9356
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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 | PT20488
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License Number State | FL
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