Provider Demographics
NPI:1508522418
Name:ELEVATE PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MASHAUN
Authorized Official - Last Name:BIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-276-2353
Mailing Address - Street 1:7745 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-6871
Mailing Address - Country:US
Mailing Address - Phone:321-276-2353
Mailing Address - Fax:
Practice Address - Street 1:7745 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-6871
Practice Address - Country:US
Practice Address - Phone:321-276-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy