Organization
ELITE SPORTS, INC.
Active
Other names
Elite Sports and Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH EDWARD CALLANAN MPT (PRESIDENT)
(781) 297-0979
Entity
Organization
Contact information
Practice address
1519 CENTRAL ST, STOUGHTON, MA 02072-4415
(781) 297-0979
(781) 297-3703
Mailing address
1519 CENTRAL ST, STOUGHTON, MA 02072-4415
(781) 297-0979
(781) 297-3703
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
51
MA
225X00000X
Occupational Therapist
51
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y61307
BCBS
MA
Enumeration date
09/15/2006
Last updated
07/12/2013
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