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Organization

ELITE WELLNESS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA M DOUGHERTY DPT, LMT, CSCI, NCTM (OWNER/THERAPIST)
(770) 316-0601
Entity
Organization

Contact information

Practice address
3315 SUGARLOAF PKWY, SUITE 5, LAWRENCEVILLE, GA 30044-5497
(770) 316-0601
Mailing address
PO BOX 428, SNELLVILLE, GA 30078-0428
(770) 316-0601

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT006185
GA

Other

Enumeration date
12/08/2009
Last updated
12/08/2009
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