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General NPI Number Information
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NPI Number | 1134636269
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Entity Type | Organization
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Legal Business Name | ELEVATION PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 985 W RIVERDALE RD STE 2
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City | RIVERDALE
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State | UT
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Zip | 84405-5601
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Country | US
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Telephone | 385-405-2712
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Fax | 888-595-6786
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Provider Business Mailing Address
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Address Line | 985 W RIVERDALE RD STE 2
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City | RIVERDALE
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State | UT
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Zip | 84405-5601
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Country | US
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Telephone | 385-405-2712
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Fax |
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Authorized Official
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Title or Position | PT DIRECTOR/OWNER
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Name | DR. JACOB D EREKSON
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Credential | DPT
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Telephone | 385-405-2712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 7376354-2401
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License Number State | UT
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