=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558064220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATE WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2023
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1667 WHITEFISH STAGE STE 200
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-253-2328
-----------------------------------------------------
Fax | 406-794-0469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5574
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-253-8924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | TYLER REESE CORWIN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 406-253-2328
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------