Provider Demographics
NPI:1497145940
Name:ELEVATE: PERFORMANCE HEALTH WELLNESS
Entity Type:Organization
Organization Name:ELEVATE: PERFORMANCE HEALTH WELLNESS
Other - Org Name:ELEVATE PHW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-341-3411
Mailing Address - Street 1:3901 SINGER BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5862
Mailing Address - Country:US
Mailing Address - Phone:505-341-3411
Mailing Address - Fax:
Practice Address - Street 1:3901 SINGER BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5862
Practice Address - Country:US
Practice Address - Phone:505-341-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty