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General NPI Number Information
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NPI Number | 1659029817
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Entity Type | Organization
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Legal Business Name | ELEVATE PHYSICAL THERAPY AND PERFORMANCE CENTER
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 314 ROUTE 70 UNIT 6
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City | LAKEHURST
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State | NJ
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Zip | 08733-2920
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Country | US
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Telephone | 848-258-2478
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Fax | 848-258-2480
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Provider Business Mailing Address
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Address Line | 314 ROUTE 70 UNIT 6
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City | LAKEHURST
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State | NJ
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Zip | 08733-2920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ CO-OWNER
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Name | WILLIAM GULLI
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Credential | DPT
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Telephone | 732-691-8300
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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 |
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License Number State |
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