Organization
ELITE PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN EUGENE VANDIVER PT (PT CO OWNER PRESIDENT)
(706) 335-3816
Entity
Organization
Contact information
Practice address
205 MERCER PL, HOMER ROAD, COMMERCE, GA 30529-1564
(706) 335-3816
(706) 335-3819
Mailing address
205 MERCER PL, HOMER ROAD, COMMERCE, GA 30529-1564
(706) 335-3816
(706) 335-3819
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004868
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00981439A
—
GA
Enumeration date
11/15/2006
Last updated
03/04/2009
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