MEDICARE: ELEVATE 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1134738362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 545
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74702-0545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-3403
Country	:	US
Telephone Number	:	580-634-2423
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALYSSE BOLLIER
Credential	:	PT
Telephone Number	:	580-920-3819

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	06/21/2021

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Directions to “ELEVATE THERAPY, PLLC ” Practice Location

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