NPIMap

Organization Active NPI

Elite Therapy Corp

  • Physical Therapist
  • Kokomo, IN
National Provider Identifier
1235693300
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ELITE THERAPY CORP
Practice address
2312 S Dixon Rd Ste 250
Kokomo, IN 46902-6426
Phone
(765) 459-7275
NPI assigned
Jan 23, 2019
Last updated
Nov 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Authorized official

Name
Melissa Dicke, PT, DPTNPI 1891018073
Title
Ceo, Owner
Phone
(914) 484-1731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

2312 S Dixon Rd Ste 250
Kokomo, IN 46902-6426

Mailing address

12647 Timber Crest Dr
Carmel, IN 46033-8639
Phone (914) 484-1731

Other practice location 1

250 Shenandoah Dr
Lafayette, IN 47905-5927
Phone (317) 325-8860

Other practice location 2

3901 High St
Logansport, IN 46947-2562
Phone (317) 325-8860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190423001980 IN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8224370242 Receives reassigned benefits from 17 practitioners
Practice locations: Fishers, IN; Indianapolis, IN; Kokomo, IN

National Provider Directory

National Provider Directory

Locations

580 E Carmel Dr
Carmel, IN 46032
Phone (317) 564-8332

7555 El Beulah Blvd
Indianapolis, IN 46256
Phone (317) 284-1893

2312 S Dixon Rd
Kokomo, IN 46902
Phone (765) 210-6850

250 Shenandoah Dr
Lafayette, IN 47905
Phone (317) 325-8860

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636588800000",
    "number": "1235693300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12647 TIMBER CREST DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460338639",
            "telephone_number": "914-484-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 S DIXON RD STE 250",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026426",
            "telephone_number": "765-459-7275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Shenandoah Dr",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479055927",
            "country_code": "US",
            "telephone_number": "317-325-8860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3901 High St",
            "address_purpose": "LOCATION",
            "city": "Logansport",
            "state": "IN",
            "postal_code": "469472562",
            "country_code": "US",
            "telephone_number": "317-325-8860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELITE THERAPY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A",
        "authorized_official_last_name": "DICKE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO, OWNER",
        "authorized_official_telephone_number": "914-484-1731",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; 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.