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General NPI Number Information
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NPI Number | 1932356870
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Entity Type | Organization
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Legal Business Name | ELEVATION PHYSICAL THERAPY AND SPORTS AND REHABILITATION, LLC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 10245 S MARYLAND PKWY 153
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City | LAS VEGAS
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State | NV
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Zip | 89183
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Country | US
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Telephone | 702-768-8050
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Fax | 702-731-2565
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Provider Business Mailing Address
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Address Line | 10245 S MARYLAND PKWY UNIT 153
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City | LAS VEGAS
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State | NV
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Zip | 89183-4041
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Country | US
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Telephone | 702-768-8050
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Fax | 702-731-2565
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MICHAEL DUDLEY RUSSELL
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Credential | DPT
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Telephone | 702-768-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1007638532
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License Number State | NV
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