Healthcare Provider Details

I. General information

NPI: 1720809601
Provider Name (Legal Business Name): ELEVATE PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 11/05/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 TWENTY MILE RD. UNIT 107
PARKER CO
80134
US

IV. Provider business mailing address

17011 LINCOLN AVE STE 338
PARKER CO
80134-3144
US

V. Phone/Fax

Practice location:
  • Phone: 870-919-3431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEXA THOMPSON
Title or Position: OWNER
Credential:
Phone: 870-919-3431