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General NPI Number Information
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NPI Number | 1346862018
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Entity Type | Organization
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Legal Business Name | ELEVATE PHYSICAL MEDICINE LLC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 700 SQUIRES PT STE B
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City | DUNCAN
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State | SC
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Zip | 29334-8879
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Country | US
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Telephone | 864-607-4327
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Fax | 864-752-1653
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Provider Business Mailing Address
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Address Line | 700 SQUIRES PT STE B
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City | DUNCAN
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State | SC
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Zip | 29334-8879
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Country | US
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Telephone | 864-607-4327
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Fax | 864-752-1653
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW WINK
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Credential |
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Telephone | 864-607-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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