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General NPI Number Information
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NPI Number | 1821256298
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Entity Type | Organization
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Legal Business Name | ELITE PHYSICAL THERAPY GROUP, LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 223 140TH ST S STE 700
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City | TACOMA
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State | WA
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Zip | 98444-4549
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Country | US
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Telephone | 253-531-5645
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Fax | 253-536-3467
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Provider Business Mailing Address
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Address Line | 21707 103RD AVENUE CT E STE B202
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City | GRAHAM
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State | WA
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Zip | 98338-8308
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Country | US
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Telephone | 253-271-7339
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Fax | 253-655-5845
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CLINIC OWNER
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Name | TREVOR WILLIAM PETTINGILL
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Credential | MPT
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Telephone | 253-732-8116
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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 | 602832882
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License Number State | WA
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