MEDICARE: ELITE PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT30080	CA

General Provider Information

NPI Number	:	1164730628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 34194
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91394-4194
Country	:	US
Telephone Number	:	818-395-7049
Fax Number	:	818-368-1412

Provider Business Practice Location Address
First Line	:	13633 VICTORY BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1735
Country	:	US
Telephone Number	:	818-395-7049
Fax Number	:	818-368-1412

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NEKTAR HOPE TOUKHLADJIAN
Credential	:	MPT
Telephone Number	:	818-395-7049

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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