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General NPI Number Information
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NPI Number | 1922861012
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Entity Type | Organization
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Legal Business Name | ELEVATED THERAPY SERVICES
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1395 LOGANDALE DR
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City | LOGANDALE
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State | NV
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Zip | 89021-8902
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Country | US
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Telephone | 801-717-6445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 791
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City | LOGANDALE
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State | NV
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Zip | 89021-0791
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Country | US
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Telephone | 801-717-6445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN VINCENT RIDER
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Credential | PHD, MS, OTR/L
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Telephone | 801-717-6445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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