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General NPI Number Information
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NPI Number | 1841721388
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Entity Type | Organization
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Legal Business Name | ELEVATE PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE 324
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-434-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 10425 W NORTH AVE 324
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-434-2578
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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 | DR. ALEX V JOSEPH
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Credential | DPT
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Telephone | 919-923-3564
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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 | 10693-24
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License Number State | WI
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