Provider Demographics
NPI:1710659974
Name:LEVEL UP WELLNESS AND PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:LEVEL UP WELLNESS AND PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-883-3534
Mailing Address - Street 1:3645 GRAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2039
Mailing Address - Country:US
Mailing Address - Phone:510-883-3534
Mailing Address - Fax:510-255-6890
Practice Address - Street 1:3645 GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2039
Practice Address - Country:US
Practice Address - Phone:510-883-3534
Practice Address - Fax:510-255-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty