Provider Demographics
NPI:1043945215
Name:ELEVATE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:662-897-4835
Mailing Address - Street 1:103 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2756
Mailing Address - Country:US
Mailing Address - Phone:662-897-4835
Mailing Address - Fax:
Practice Address - Street 1:103 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2756
Practice Address - Country:US
Practice Address - Phone:662-897-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty