MEDICARE: LEVEL UP PHYSICAL THERAPY

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	225200000X	Physical Therapy Assistant
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1871117705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVEL UP PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6420 SEMINOLE TRL STE L4
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2836
Country	:	US
Telephone Number	:	808-347-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 SEMINOLE TRL STE L4
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2836
Country	:	US
Telephone Number	:	808-347-1105
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	NATASHA PENA
Credential	:	PTA, SPT
Telephone Number	:	808-347-1105

Provider Enumeration Date	:	06/06/2020
Last Update Date	:	03/10/2021

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Directions to “LEVEL UP PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

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