Provider Demographics
NPI:1508367087
Name:LEVEL UP PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LEVEL UP PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-581-2338
Mailing Address - Street 1:10000 BEACH DR SW UNIT 9
Mailing Address - Street 2:
Mailing Address - City:CAROLINA SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2856
Mailing Address - Country:US
Mailing Address - Phone:757-581-2338
Mailing Address - Fax:
Practice Address - Street 1:10000 BEACH DR SW UNIT 9
Practice Address - Street 2:
Practice Address - City:CAROLINA SHORES
Practice Address - State:NC
Practice Address - Zip Code:28467
Practice Address - Country:US
Practice Address - Phone:757-581-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty