Provider Demographics
NPI:1144735721
Name:ELEVATE PHYSICAL REHABILITATION GROUP PLLC
Entity type:Organization
Organization Name:ELEVATE PHYSICAL REHABILITATION GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:V
Authorized Official - Last Name:LODATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:425-402-9772
Mailing Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-9917
Mailing Address - Country:US
Mailing Address - Phone:844-567-1254
Mailing Address - Fax:425-413-4402
Practice Address - Street 1:17618 140TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6800
Practice Address - Country:US
Practice Address - Phone:425-402-9772
Practice Address - Fax:425-402-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty