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General NPI Number Information
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NPI Number | 1710659974
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Entity Type | Organization
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Legal Business Name | LEVEL UP WELLNESS AND PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 3645 GRAND AVE STE 203
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City | OAKLAND
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State | CA
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Zip | 94610-2039
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Country | US
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Telephone | 510-883-3534
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Fax | 510-255-6890
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Provider Business Mailing Address
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Address Line | 3645 GRAND AVE STE 203
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City | OAKLAND
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State | CA
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Zip | 94610-2039
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Country | US
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Telephone | 510-883-3534
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Fax | 510-255-6890
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN OVERTON
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Credential |
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Telephone | 510-883-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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