Provider Demographics
NPI:1518483262
Name:ELEVATE SPORTS PERFORMANCE AND REHAB, LLC
Entity Type:Organization
Organization Name:ELEVATE SPORTS PERFORMANCE AND REHAB, LLC
Other - Org Name:ELEVATE SPORTS PERFORMANCE & HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-558-2151
Mailing Address - Street 1:6658 W SUNSET RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3297
Mailing Address - Country:US
Mailing Address - Phone:702-558-2151
Mailing Address - Fax:702-579-9877
Practice Address - Street 1:6658 W SUNSET RD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3297
Practice Address - Country:US
Practice Address - Phone:702-558-2151
Practice Address - Fax:702-579-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01640111N00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty