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General NPI Number Information
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NPI Number | 1194549105
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Entity Type | Organization
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Legal Business Name | ELEVATION PHYSICAL THERAPY & PERFORMANCE PLLC MAURICE DISLEY SOLE MBR
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 340 MCKINSTRY AVE STE 250
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City | CHICOPEE
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State | MA
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Zip | 01013-1849
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Country | US
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Telephone | 413-285-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 58 BURNETT ST APT 2
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City | GRANBY
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State | MA
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Zip | 01033-3312
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Country | US
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Telephone | 413-285-4015
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MAURICE PATRICK DISLEY IV
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Credential |
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Telephone | 413-285-4015
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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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