Provider Demographics
NPI:1952947616
Name:LIFE OUT LOUD, LLC
Entity Type:Organization
Organization Name:LIFE OUT LOUD, LLC
Other - Org Name:ELEVATE PHYSICAL THERAPY FITNESS AND PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-887-2030
Mailing Address - Street 1:2312 S 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4340
Mailing Address - Country:US
Mailing Address - Phone:541-887-2030
Mailing Address - Fax:541-887-2070
Practice Address - Street 1:2312 S 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4340
Practice Address - Country:US
Practice Address - Phone:541-236-2123
Practice Address - Fax:888-706-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty