Provider Demographics
NPI:1871909366
Name:ELITE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:515-331-6508
Mailing Address - Street 1:5721 MERLE HAY RD
Mailing Address - Street 2:SUITE 14A
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1261
Mailing Address - Country:US
Mailing Address - Phone:515-331-6508
Mailing Address - Fax:515-331-6508
Practice Address - Street 1:5721 MERLE HAY RD
Practice Address - Street 2:SUITE 14A
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1261
Practice Address - Country:US
Practice Address - Phone:515-331-6508
Practice Address - Fax:515-331-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty