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NPI Code Detail

MEDICARE: ELEVATE PHYSICAL THERAPY, LLC

MEDICARE: ELEVATE PHYSICAL THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11851815823OTHERFLNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053043992
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELEVATE PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 500 MAGUIRE PARK ST APT 211
Second Line :
City : OCOEE
State : FL
Zip : 34761-4921
Country : US
Telephone Number : 612-325-6126
Fax Number :
Provider Business Practice Location Address
First Line : 3554 W ORANGE COUNTRY CLUB DR STE 230
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-5306
Country : US
Telephone Number : 612-325-6126
Fax Number :
Authorized Official
Title or Position : PHYSICAL THERAPIST
Name : SADIE KILLEEN SWIDERSKI
Credential : DPT
Telephone Number : 612-325-6126
Provider Enumeration Date : 06/29/2022
Last Update Date : 10/22/2022

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Directions to “ELEVATE PHYSICAL THERAPY, LLC ” Practice Location

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