Provider Demographics
NPI:1205542628
Name:ELITE EDGE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:ELITE EDGE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANICEK
Authorized Official - Last Name:OSOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:804-215-6191
Mailing Address - Street 1:PO BOX 11394
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5108 ARGUS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2320
Practice Address - Country:US
Practice Address - Phone:804-215-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty