Provider Demographics
NPI:1053043992
Name:ELEVATE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:KILLEEN
Authorized Official - Last Name:SWIDERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:612-325-6126
Mailing Address - Street 1:500 MAGUIRE PARK ST APT 211
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4921
Mailing Address - Country:US
Mailing Address - Phone:612-325-6126
Mailing Address - Fax:
Practice Address - Street 1:3554 W ORANGE COUNTRY CLUB DR STE 230
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5306
Practice Address - Country:US
Practice Address - Phone:612-325-6126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1851815823OtherNPI
MN1851815823Medicaid