Healthcare Provider Details

I. General information

NPI: 1285553404
Provider Name (Legal Business Name): RELEVATE PERFORMANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOLMES CIR
FARMINGTON CT
06032-2507
US

IV. Provider business mailing address

21 HOLMES CIR
FARMINGTON CT
06032-2507
US

V. Phone/Fax

Practice location:
  • Phone: 860-809-5228
  • Fax:
Mailing address:
  • Phone: 860-809-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JORDAN NIHOUL
Title or Position: OWNER/FOUNDER
Credential: DPT, ATC
Phone: 860-809-5228