Organization
CLUB ELITE, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH CAROCCIO DPT (OWNER)
(954) 336-5639
Entity
Organization
Contact information
Practice address
8430 BLUE MOUNTAIN AVE, BOYNTON BEACH, FL 33473-5080
(954) 474-3611
Mailing address
11870 W STATE ROAD 84 STE C3, DAVIE, FL 33325-3811
(954) 474-3611
(954) 474-3613
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887989300
—
FL
Enumeration date
04/17/2019
Last updated
08/20/2019
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