Elite Rehab LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ELITE REHAB LLC

Practice address

616 E Shepherd Ave
Kirksville, MO 63501-4711

Phone

(660) 956-9925

Fax

(660) 956-9924

NPI assigned

Dec 29, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandon Lee MackNPI 1134188832

Title

Owner

Phone

(660) 956-9925

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon Lee Mack, D.P.T.

  • Physical Therapist
  • Kirksville, MO
  • NPI 1134188832
  Medicare reassignment NPD Authorized official
• Ronald L Danielson Jr., MPT, MS

  • Physical Therapist
  • Kirksville, MO
  • NPI 1659676674
  NPD
• Amity Sparks Marcial, DPT

  • Physical Therapist
  • Van Buren, AR
  • NPI 1669727525

  Multi-Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1766966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777334400000",
    "number": "1205792850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 E SHEPHERD AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014711",
            "telephone_number": "660-956-9925",
            "fax_number": "660-956-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 E SHEPHERD AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014711",
            "telephone_number": "660-956-9925",
            "fax_number": "660-956-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-29",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-956-9925"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audelia Eben, DO
• Allison Nichole Edwards, RD
• Dana Elam, LCSW
• Abigail Elbert
• Jennifer Lynn Eldridge Houser, CHES
• Zarinah Ell
• Ellendel Isl LLC (Ellendel ISL)
• Elliott Pharmacy Inc (Elliott Pharmacy LTC)
• Elliott Pharmacy Inc (Elliott HealthMart Pharmacy)
• Elliott Pharmacy, Inc.

• Physical Therapist in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.