Provider Demographics
NPI:1033756242
Name:ELEVATE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:402-202-4738
Mailing Address - Street 1:4463 S 110TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1216
Mailing Address - Country:US
Mailing Address - Phone:402-427-3169
Mailing Address - Fax:
Practice Address - Street 1:4463 S 110TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1216
Practice Address - Country:US
Practice Address - Phone:402-427-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386057289OtherJOSIAH NPI NUMBER
1598071078OtherJULIE'S NPI NUMBER