Healthcare Provider Details

I. General information

NPI: 1558064220
Provider Name (Legal Business Name): ELEVATE WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 WHITEFISH STAGE STE 200
KALISPELL MT
59901-2173
US

IV. Provider business mailing address

PO BOX 5574
WHITEFISH MT
59937-5574
US

V. Phone/Fax

Practice location:
  • Phone: 406-253-2328
  • Fax: 406-794-0469
Mailing address:
  • Phone: 406-253-8924
  • 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: TYLER REESE CORWIN
Title or Position: MANAGER/PHYSICAL THERAPIST
Credential: DPT
Phone: 406-253-2328