Healthcare Provider Details

I. General information

NPI: 1346019247
Provider Name (Legal Business Name): ELEVATE 360 PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 N BELT HWY STE A
SAINT JOSEPH MO
64506-2269
US

IV. Provider business mailing address

2335 N BELT HWY STE A
SAINT JOSEPH MO
64506-2269
US

V. Phone/Fax

Practice location:
  • Phone: 816-689-0328
  • Fax: 816-841-4320
Mailing address:
  • Phone: 816-689-0328
  • 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: ABBY BODENHAUSEN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 913-638-7438