Provider Demographics
NPI:1659029817
Name:ELEVATE PHYSICAL THERAPY AND PERFORMANCE CENTER
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY AND PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-691-8300
Mailing Address - Street 1:314 ROUTE 70 UNIT 6
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733-2920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 ROUTE 70 UNIT 6
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-2920
Practice Address - Country:US
Practice Address - Phone:848-258-2478
Practice Address - Fax:848-258-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy