| Organization Name: | ELITE PHYSICAL THERAPY AND HEALTH, LLC |
| NPI Number: | 1255567236 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CURTIS ANGUS MASON (OWNER) |
| Mailing Address: | 1255 Oakley Ave Burley |
| State: | ID US |
| Postal Code: | 833181832 |
| Phone Number: | 2086782155 |
| Fax Number: | 2086782153 |
| NPI Enumeration Date: | 06/04/2009 |
| NPI Last Update Date: | 06/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT-2031 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |