Provider Demographics
NPI:1245887272
Name:ELEVATE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-605-0416
Mailing Address - Street 1:7701 NE HIGHWAY 99 STE 109
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8871
Mailing Address - Country:US
Mailing Address - Phone:360-605-0416
Mailing Address - Fax:360-605-0417
Practice Address - Street 1:7701 NE HIGHWAY 99 STE 109
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8871
Practice Address - Country:US
Practice Address - Phone:360-605-0416
Practice Address - Fax:360-605-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT-60735053OtherWA STATE LICENSE
OR61158OtherOR STATE LICENSE