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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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