Organization
ELITE PHYSICAL THERAPY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR WILLIAM PETTINGILL MPT (PHYSICAL THERAPIST/CLINIC OWNER)
(253) 732-8116
Entity
Organization
Contact information
Practice address
223 140TH ST S STE 700, TACOMA, WA 98444-4549
(253) 531-5645
(253) 536-3467
Mailing address
21707 103RD AVENUE CT E STE B202, GRAHAM, WA 98338-8308
(253) 271-7339
(253) 655-5845
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
602832882
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001745
—
WA
01
—
G8876026
MEDICARE PTAN #
—
Enumeration date
06/02/2008
Last updated
09/20/2022
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