Provider Demographics
NPI:1063033587
Name:LIFE ELEVATED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LIFE ELEVATED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:435-230-1062
Mailing Address - Street 1:970 W 520 N
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-2414
Mailing Address - Country:US
Mailing Address - Phone:435-230-1062
Mailing Address - Fax:
Practice Address - Street 1:750 W 1075 S STE E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3264
Practice Address - Country:US
Practice Address - Phone:435-230-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty