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General NPI Number Information
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NPI Number | 1003257601
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Entity Type | Organization
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Legal Business Name | ELEVATE REHAB, LLC
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 545 E MAIN ST STE B
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City | LANDER
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State | WY
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Zip | 82520-3470
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Country | US
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Telephone | 307-335-3471
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Fax | 307-332-5388
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Provider Business Mailing Address
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Address Line | 545 E MAIN ST STE B
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City | LANDER
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State | WY
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Zip | 82520-3470
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Country | US
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Telephone | 307-335-3471
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Fax | 307-332-5388
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE L MAZUR
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Credential |
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Telephone | 307-335-3471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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