| Organization Name: | ELITE PHYSICAL THERAPY AND WELLNESS |
| NPI Number: | 1912059700 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY JOHN JACOB (EXECUTIVE OFFICER) |
| Mailing Address: | 4053 S Lapeer Rd Suite C Metamora |
| State: | MI US |
| Postal Code: | 484558721 |
| Phone Number: | 8106783202 |
| Fax Number: | 8106783205 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 04/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5501011436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |