| Organization Name: | ELITE PHYSICAL THERAPY, INC. |
| NPI Number: | 1164594859 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN EUGENE VANDIVER (PT CO OWNER PRESIDENT) |
| Mailing Address: | 205 Mercer Pl Homer Road Commerce |
| State: | GA US |
| Postal Code: | 305291564 |
| Phone Number: | 7063353816 |
| Fax Number: | 7063353819 |
| NPI Enumeration Date: | 11/15/2006 |
| NPI Last Update Date: | 03/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT004868 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |