Provider Demographics
NPI:1265123657
Name:ELEVATED PHYSICAL THERAPY & FITNESS PLLC
Entity type:Organization
Organization Name:ELEVATED PHYSICAL THERAPY & FITNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-740-0290
Mailing Address - Street 1:57 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-2051
Mailing Address - Country:US
Mailing Address - Phone:541-740-0290
Mailing Address - Fax:
Practice Address - Street 1:57 TOWN FARM RD
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-2051
Practice Address - Country:US
Practice Address - Phone:541-740-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty