NPIMap

Organization Active NPI

Elite Wellness Inc

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1972832772
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT006185 Issued in GA
Legal business name
ELITE WELLNESS INC
Practice address
3315 Sugarloaf Pkwy
Suite 5
Lawrenceville, GA 30044-5497
Phone
(770) 316-0601
NPI assigned
Dec 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Authorized official

Name
Lisa M Dougherty, DPT, LMT, CSCI, NCTMNPI 1164538773
Title
Owner/Therapist
Phone
(770) 316-0601

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT006185 GA Primary

Addresses

Primary practice location

3315 Sugarloaf Pkwy
Suite 5
Lawrenceville, GA 30044-5497

Mailing address

PO Box 428
Snellville, GA 30078-0428
Phone (770) 316-0601

National Provider Directory

National Provider Directory

Locations

3315 Sugarloaf Pkwy
Ste 5
Lawrenceville, GA 30044
Phone (770) 316-0601

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1972832772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300780428",
            "telephone_number": "770-316-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 SUGARLOAF PKWY",
            "address_2": "SUITE 5",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445497",
            "telephone_number": "770-316-0601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "770-316-0601",
        "authorized_official_credential": "DPT, LMT, CSCI, NCTM"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT006185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.