Provider Demographics
NPI:1871142968
Name:ELEVATE PHYSICAL THERAPY & PERFORMANCE
Entity type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-427-5530
Mailing Address - Street 1:180 S BRADY ST
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1147
Mailing Address - Country:US
Mailing Address - Phone:724-516-6147
Mailing Address - Fax:
Practice Address - Street 1:180 S BRADY ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1147
Practice Address - Country:US
Practice Address - Phone:724-516-6147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy