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General NPI Number Information
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NPI Number | 1447120548
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Entity Type | Organization
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Legal Business Name | ELEVATE PEDIATRIC THERAPY
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 303 SW 18TH ST STE 1&3
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City | BENTONVILLE
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State | AR
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Zip | 72712-7840
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Country | US
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Telephone | 479-659-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 SW RADIANCE AVE
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City | BENTONVILLE
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State | AR
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Zip | 72713-2135
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Country | US
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Telephone | 479-659-1899
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Fax |
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Authorized Official
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Title or Position | OWNER/SLP
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Name | KAYLEE ALDER
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Credential | M.S., CCC-SLP
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Telephone | 479-659-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 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 #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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