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General NPI Number Information
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NPI Number | 1346019247
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Entity Type | Organization
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Legal Business Name | ELEVATE 360 PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 2335 N BELT HWY STE A
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2269
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Country | US
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Telephone | 816-689-0328
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Fax | 816-841-4320
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Provider Business Mailing Address
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Address Line | 2335 N BELT HWY STE A
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2269
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Country | US
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Telephone | 816-689-0328
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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 | ABBY BODENHAUSEN
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Credential | DPT
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Telephone | 913-638-7438
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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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