MEDICARE: ELEVATE SPORTS PERFORMANCE AND REHAB, LLC

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	208100000X	Physical Medicine & Rehabilitation Physician
2	111N00000X	Chiropractor	B01640	NV

General Provider Information

NPI Number	:	1518483262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE SPORTS PERFORMANCE AND REHAB, LLC

Provider Business Mailing Address
First Line	:	6658 W SUNSET RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3297
Country	:	US
Telephone Number	:	702-558-2151
Fax Number	:	702-579-9877

Provider Business Practice Location Address
First Line	:	6658 W SUNSET RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3297
Country	:	US
Telephone Number	:	702-558-2151
Fax Number	:	702-579-9877

Authorized Official
Title or Position	:	MANAGER
Name	:	KATHLEEN SCHARF
Credential	:	DC
Telephone Number	:	702-558-2151

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	03/29/2023

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