Healthcare Provider Details

I. General information

NPI: 1295314979
Provider Name (Legal Business Name): ELEVATE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BRAMBLE CT
NEWBERG OR
97132-9512
US

IV. Provider business mailing address

1601 E BRAMBLE CT
NEWBERG OR
97132-9512
US

V. Phone/Fax

Practice location:
  • Phone: 503-290-9313
  • Fax:
Mailing address:
  • Phone: 503-290-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL KANG
Title or Position: OWNER
Credential: PT, DPT
Phone: 503-290-9313