MEDICARE: ELITE PHYSICAL THERAPY & WELLNESS CENTER, 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	2255A2300X	Athletic Trainer	119202562	DC
2	225100000X	Physical Therapist	2705	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K3250001	OTHER	DC	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1871647024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PHYSICAL THERAPY & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	2233 WISCONSIN AVE NW
Second Line	:	SUITE 311
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4104
Country	:	US
Telephone Number	:	202-965-8901
Fax Number	:	202-965-8903

Provider Business Practice Location Address
First Line	:	2233 WISCONSIN AVE NW
Second Line	:	SUITE 311
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4104
Country	:	US
Telephone Number	:	202-965-8901
Fax Number	:	202-965-8903

Authorized Official
Title or Position	:	PHYSICAL THERAPIST- DIRECTOR
Name	:	MS. TERRY ANN SNEED
Credential	:	P.T., A.T.C.
Telephone Number	:	202-965-8901

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/07/2013

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