MEDICARE: ELEVATE PHYSICAL THERAPY, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1811842875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	140 KEN LN
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-8803
Country	:	US
Telephone Number	:	270-994-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 MEMORIAL DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-6793
Country	:	US
Telephone Number	:	270-994-7546
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MARY KELLER
Credential	:	DPT
Telephone Number	:	270-994-7546

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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