Organization
ELITE PHYSICAL THERAPY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL VAN JOHNSON PT (OWNER)
(662) 869-9980
Entity
Organization
Contact information
Practice address
113 TOWN CREEK DR, SALTILLO, MS 38866
(662) 869-9980
Mailing address
PO BOX 420, SALTILLO, MS 38866-0420
(662) 869-9980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3345
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04185220
—
MS
Enumeration date
01/19/2007
Last updated
08/22/2020
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