Elite Therapy and Wellness Center, Inc.

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

ELITE THERAPY AND WELLNESS CENTER, INC.

Practice address

3715 Thatcher Ave
Pueblo, CO 81005-1255

Phone

(719) 470-2281

Fax

(719) 301-7218

NPI assigned

Apr 4, 2016

Last updated

Mar 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy Ann Weldon, RN

Title

Owner

Phone

(719) 543-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508229782. Details of each certification follow.

• CCN 066660 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 066660

Legal name

ELITE THERAPY AND WELLNESS CENTER INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Aug 20, 2021

Last certification

Jun 3, 2024

Ownership / control type

Proprietary

Facility address

3715 Thatcher Ave
Pueblo, CO 81005

Locations

Practitioners 1

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.

• Fred Worth

  • Physical Therapy Assistant
  • Pueblo, CO
  • NPI 1649054362
  NPD

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1508229782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 THATCHER AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051255",
            "telephone_number": "719-470-2281",
            "fax_number": "719-301-7218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 THATCHER AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051255",
            "telephone_number": "719-470-2281",
            "fax_number": "719-301-7218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE THERAPY AND WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-04",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "WELDON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-543-2700",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000197949",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elevate Healthcare LLC
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• Elevate Healthcare LLC Labs
• Elevate Mental Wellness, LLC
• Rochelle Yvonne Elijah, M.D.
• Elizabeth Behm, LLC
• Elizabeth Yaeger
• Carol Elizondo Hill
• Emily Eller
• Ellington Eyecare PLLC

• Rehabilitation Clinic/Center in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Rehabilitation Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.