Provider Demographics
NPI:1043091531
Name:ELEVATE208 PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELEVATE208 PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-254-1858
Mailing Address - Street 1:2277 W MALAD AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8264
Mailing Address - Country:US
Mailing Address - Phone:307-254-1858
Mailing Address - Fax:
Practice Address - Street 1:7736 N GOVERNMENT WAY STE 1
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-8772
Practice Address - Country:US
Practice Address - Phone:307-254-1858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy