Provider Demographics
NPI:1497114441
Name:ELEVATED FITNESS LLC
Entity Type:Organization
Organization Name:ELEVATED FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS, CNS, CES, APT
Authorized Official - Phone:775-720-4904
Mailing Address - Street 1:PO BOX 11574
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-3574
Mailing Address - Country:US
Mailing Address - Phone:530-318-8666
Mailing Address - Fax:
Practice Address - Street 1:4000 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7071
Practice Address - Country:US
Practice Address - Phone:530-318-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6227133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty