Provider Demographics
NPI:1144881285
Name:ELEVATE PERFORMANCE
Entity type:Organization
Organization Name:ELEVATE PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-484-9019
Mailing Address - Street 1:PO BOX 3404
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3404
Mailing Address - Country:US
Mailing Address - Phone:605-484-9019
Mailing Address - Fax:
Practice Address - Street 1:420 E SAINT PATRICK ST STE 101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4200
Practice Address - Country:US
Practice Address - Phone:605-484-9019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty