Basic Information
| Provider Information | |||||||||
| NPI: | 1104876119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE PHYSICAL THERAPY AND ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1114 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316840027 | ||||||||
| FaxNumber: | 9326840112 | ||||||||
| Practice Location | |||||||||
| Address1: | 3310 ASPEN GROVE DR | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152249810 | ||||||||
| FaxNumber: | 6152249844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 10/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHOEMAKE | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINES ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9316840027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.