1245887272 NPI number — ELEVATE PHYSICAL THERAPY

Table of content: (NPI 1245887272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245887272 NPI number — ELEVATE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATE PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245887272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7701 NE HIGHWAY 99 STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98665-8871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-605-0416
Provider Business Mailing Address Fax Number:
360-605-0417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 NE HIGHWAY 99 STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98665-8871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-605-0416
Provider Business Practice Location Address Fax Number:
360-605-0417
Provider Enumeration Date:
08/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MORTENSEN
Authorized Official First Name:
GREGGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-605-0416

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT-60735053 . This is a "WA STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 61158 . This is a "OR STATE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com