Provider Demographics
NPI:1033980552
Name:ELEVATE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MULDOON
Authorized Official - Last Name:BRAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-233-7442
Mailing Address - Street 1:9 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2106
Mailing Address - Country:US
Mailing Address - Phone:617-233-7442
Mailing Address - Fax:
Practice Address - Street 1:9 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2106
Practice Address - Country:US
Practice Address - Phone:617-233-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty