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General NPI Number Information
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NPI Number | 1407115330
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Entity Type | Organization
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Legal Business Name | ELEVATE PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 05/12/2012
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Last Update Date | 05/12/2012
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Provider Practice Location Address
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Address Line | 23880 NE 8TH ST
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City | SAMMAMISH
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State | WA
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Zip | 98074-3604
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Country | US
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Telephone | 425-458-2046
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Fax | 425-458-2047
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Provider Business Mailing Address
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Address Line | 23860 NE 8TH ST
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City | SAMMAMISH
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State | WA
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Zip | 98074-3604
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Country | US
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Telephone | 425-458-2046
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Fax | 425-458-2047
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | KAROL A WILSON
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Credential | PT, DPT
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Telephone | 425-458-2046
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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 | 603176468
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License Number State | WA
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