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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1912572314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	13819 N 42ND PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5847
Country	:	US
Telephone Number	:	602-448-8785
Fax Number	:

Provider Business Practice Location Address
First Line	:	13819 N 42ND PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5847
Country	:	US
Telephone Number	:	602-448-8785
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEVON TURNBULL
Credential	:	DPT
Telephone Number	:	602-448-8785

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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