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General NPI Number Information
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NPI Number | 1881139889
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 2901 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-1360
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Country | US
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Telephone | 254-899-8255
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Fax | 254-235-3408
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Provider Business Mailing Address
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Address Line | 220 WHISPERING OAKS
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City | CHINA SPRING
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State | TX
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Zip | 76633-3507
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Country | US
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Telephone | 254-899-8255
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Fax | 254-235-3408
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KARI MCKOWAN
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Credential | OTR
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Telephone | 254-899-8255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | TX
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