# ELITE PHYSICAL THERAPY AND SPORTS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235180811
- **Authorized official:** MARK STACK PT (OWNER-MANAGER)
- **Authorized official phone:** (808) 572-7790

## Contact information

- **Practice address:** 1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
- **Practice address phone:** (808) 572-7790
- **Practice address fax:** (808) 573-4721
- **Mailing address:** 1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
- **Mailing address phone:** (808) 572-7790
- **Mailing address fax:** (808) 573-4721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | W6201699001 | HI | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 08/22/2020