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General NPI Number Information
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NPI Number | 1861964520
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Entity Type | Organization
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Legal Business Name | ELEVATED PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 44 MARKFIELD DR STE B
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City | CHARLESTON
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State | SC
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Zip | 29407-7908
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Country | US
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Telephone | 843-364-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 2347 TALL SAIL DR APT L
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City | CHARLESTON
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State | SC
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Zip | 29414-6639
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Country | US
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Telephone | 843-364-1747
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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 | TRACEY LEANN MANASCO
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Credential | PT
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Telephone | 843-364-1747
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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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