MEDICARE: ELEVATION REHAB, 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1487246088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION REHAB, LLC

Provider Business Mailing Address
First Line	:	13836 CYRUS CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-7226
Country	:	US
Telephone Number	:	908-436-7517
Fax Number	:

Provider Business Practice Location Address
First Line	:	13836 CYRUS CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-7226
Country	:	US
Telephone Number	:	908-436-7517
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	CHRISTINE MAXIMOS
Credential	:	OTR/L
Telephone Number	:	908-436-7517

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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Directions to “ELEVATION REHAB, LLC ” Practice Location

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