Healthcare Provider Details

I. General information

NPI: 1316710783
Provider Name (Legal Business Name): ELEVATE PD & THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9052 MANCHESTER ST
SPRING HILL FL
34606-1323
US

IV. Provider business mailing address

9052 MANCHESTER ST
SPRING HILL FL
34606-1323
US

V. Phone/Fax

Practice location:
  • Phone: 342-345-6218
  • Fax:
Mailing address:
  • Phone: 342-345-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH EDITH REYES
Title or Position: PRESIDENT/ CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 352-345-6218