# ELITE PHYSICAL MEDICINE PLLC

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

## Provider details

- **NPI number:** 1821632241
- **Authorized official:** JACOB STUTZ (ADMINISTRATOR)
- **Authorized official phone:** (832) 622-6031

## Contact information

- **Practice address:** 3535 VICTORY GROUP WAY STE 505, FRISCO, TX 75034-6732
- **Practice address phone:** (832) 622-6031
- **Mailing address:** 3535 VICTORY GROUP WAY STE 505, FRISCO, TX 75034-6732

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2019
- **Last updated:** 10/29/2019