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General NPI Number Information
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NPI Number | 1962011387
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Entity Type | Organization
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Legal Business Name | ELEVATION PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 128 MIDDLE ST
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City | FARMINGTON
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State | ME
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Zip | 04938-6937
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Country | US
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Telephone | 801-540-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 348 WALKER HILL RD
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City | WILTON
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State | ME
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Zip | 04294-4619
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Country | US
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Telephone | 801-540-2840
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KATHRYN LONGHURST
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Credential |
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Telephone | 801-540-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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