Healthcare Provider Details

I. General information

NPI: 1336597921
Provider Name (Legal Business Name): ELEVATION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 YOUNGFIELD ST STE 110
GOLDEN CO
80401-3595
US

IV. Provider business mailing address

1901 YOUNGFIELD ST STE 110
GOLDEN CO
80401-3595
US

V. Phone/Fax

Practice location:
  • Phone: 720-446-9408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0012073
License Number StateCO

VIII. Authorized Official

Name: JULIE BARR
Title or Position: OWNER
Credential: P.T.
Phone: 720-446-9408