Provider Demographics
NPI:1922861012
Name:ELEVATED THERAPY SERVICES
Entity Type:Organization
Organization Name:ELEVATED THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS, OTR/L
Authorized Official - Phone:801-717-6445
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:LOGANDALE
Mailing Address - State:NV
Mailing Address - Zip Code:89021-0791
Mailing Address - Country:US
Mailing Address - Phone:801-717-6445
Mailing Address - Fax:
Practice Address - Street 1:1395 LOGANDALE DR
Practice Address - Street 2:
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021-8902
Practice Address - Country:US
Practice Address - Phone:801-717-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty