MEDICARE: ELEVATE PHYSICAL THERAPY AND REHABILITATION

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1619591146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE PHYSICAL THERAPY AND REHABILITATION

Provider Business Mailing Address
First Line	:	15A WICKATUNK RD
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-2719
Country	:	US
Telephone Number	:	732-631-4233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 JOANNA CT STE E
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2283
Country	:	US
Telephone Number	:	732-631-4233
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MRS. DANIELLE MENDEZ
Credential	:	PT, MSPT, OCS
Telephone Number	:	732-631-4233

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	11/23/2020

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