Elite Therapy and Wellness
Organization Active NPI Physical Therapy Clinic/Center · Imboden, AR
NPI 1679071302 · NPPES record last updated May 12, 2021
Key facts
- NPI
- 1679071302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- PT2712 (AR)
- Legal business name
- ELITE THERAPY AND WELLNESS
- Practice address
- 5552 US Hwy 63
Suite B
Imboden, AR 72434 - Phone
- (870) 869-2770
- Fax
- (870) 869-7221
- NPI assigned
- Jan 29, 2018
- Organization subpart
- No
Authorized official
- Name
- Holli Dawn Lillard
- Title
- Owner
- Phone
- (870) 869-7220
Practitioners 3
-
Holli Dawn Lillard, DPT
-
Angela Marie Roberts, MHPP
-
Samantha Hogard, PTA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180328001403 | AR | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5294097473 |
Receives reassigned benefits from 1 practitioner Practice locations: Imboden, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT2712 | AR | |
| Physical Therapy Clinic/Center | 261QP2000X | PT2712 | AR | Yes |
Addresses
Primary practice location
5552 US Hwy 63
Suite B
Imboden, AR 72434
Mailing address
PO Box 334
Imboden, AR 72434-0334
Phone (870) 869-2770
Other names
- Holli Lillard
Other providers in Imboden, AR
- Carla Renee Brown
- Cornerstone Community Counseling Corp
- Rose Anna Crawford
- Shara Jane Dail
- Dayspring Behavioral Health
- Julie Michelle Fort
- Genesis Health and Wellness, PLLC
- Elizabeth Hardin
- Mya Hart
- Samantha Hogard
All providers in Imboden, AR · Physical Therapy Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.