MEDICARE: ELEVATION ATHLETICS PHYSICAL THERAPY AND PERFORMANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1205590700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION ATHLETICS PHYSICAL THERAPY AND PERFORMANCE

Provider Business Mailing Address
First Line	:	441 PRAIRIE VIEW DR
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3070
Country	:	US
Telephone Number	:	909-732-6859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 N TARRANT PKWY STE 230
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5387
Country	:	US
Telephone Number	:	682-800-3017
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	RYAN PEREZ
Credential	:	PT, DPT, OCS, CSCS
Telephone Number	:	682-800-3017

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/24/2023

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Directions to “ELEVATION ATHLETICS PHYSICAL THERAPY AND PERFORMANCE ” Practice Location

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