MEDICARE: ELEVATION PHYSICAL THERAPY, PLLC

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
1	2251X0800X	Orthopedic Physical Therapist	0012767	CO

General Provider Information

NPI Number	:	1053720789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	2533 W DUNKELD PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 W DUNKELD PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3738
Country	:	US
Telephone Number	:	970-213-9008
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	KARSON RIZLEY
Credential	:
Telephone Number	:	970-213-9008

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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