=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861363806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELITE PIERRE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 WINNING TICKET DR
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29045-7131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-233-6932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 WINNING TICKET DR
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29045-7131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-233-6932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------