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General NPI Number Information
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NPI Number | 1285445395
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Entity Type | Organization
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Legal Business Name | ELEVATE THERAPY DORAL LLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 4005 NW 114TH AVE UNIT 2
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City | DORAL
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State | FL
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Zip | 33178-4372
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Country | US
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Telephone | 786-828-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 8930 W FLAGLER ST APT 212
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City | MIAMI
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State | FL
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Zip | 33174-3958
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Country | US
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Telephone | 305-804-2277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE MARIE GONZALEZ
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Credential | DPT
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Telephone | 305-804-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine 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 | 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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