Healthcare Provider Details

I. General information

NPI: 1285445395
Provider Name (Legal Business Name): ELEVATE THERAPY DORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 NW 114TH AVE UNIT 2
DORAL FL
33178-4372
US

IV. Provider business mailing address

8930 W FLAGLER ST APT 212
MIAMI FL
33174-3958
US

V. Phone/Fax

Practice location:
  • Phone: 786-828-6161
  • Fax:
Mailing address:
  • Phone: 305-804-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MARIE GONZALEZ
Title or Position: OWNER
Credential: DPT
Phone: 305-804-2277