| NPI | 1558951913 |
|---|---|
| Former Legal Business Name | ELITE HEALTH AND PERFORMANCE CENTER, PLLC |
| Entity Type | Organization |
| Authorized Contact | DEREK ALAN LEIST Owner 615-636-5923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |