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General NPI Number Information
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NPI Number | 1497564181
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Entity Type | Organization
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Legal Business Name | ELEVATE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 6589 LAKETOWNE PL
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City | ALBERTVILLE
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State | MN
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Zip | 55301-6500
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Country | US
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Telephone | 763-220-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 7272 MARTIN FARMS AVE NE
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City | OTSEGO
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State | MN
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Zip | 55330-4815
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Country | US
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Telephone | 320-491-5199
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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 | BETH A PESTA
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Credential | DPT
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Telephone | 320-491-5199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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