Organization Name: | ELITE SPORTS THERAPY INC |
NPI Number: | 1013151489 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL WILLIAM RAE (MEDICAL DIRECTOR/OWNER) |
Mailing Address: | 1184 N Gilbert Rd Ste 100 Gilbert |
State: | AZ US |
Postal Code: | 852342476 |
Phone Number: | 4803901962 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2009 |
NPI Last Update Date: | 04/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 8028 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |