Basic Information
| Provider Information | |||||||||
| NPI: | 1811482599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE PT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4825 KENNETT PIKE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198071813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024771536 | ||||||||
| FaxNumber: | 3024771564 | ||||||||
| Practice Location | |||||||||
| Address1: | 4825 KENNETT PIKE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198071813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024771536 | ||||||||
| FaxNumber: | 3024771564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | KNARR | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | FRANKLIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3023818348 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | J1-0000675 | DE | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | J1-0000675 | DE | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.