Provider Demographics
NPI:1780329441
Name:LONGEVITY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LONGEVITY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-979-2997
Mailing Address - Street 1:1807 S CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3201
Mailing Address - Country:US
Mailing Address - Phone:509-979-2997
Mailing Address - Fax:
Practice Address - Street 1:1872 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3137
Practice Address - Country:US
Practice Address - Phone:720-819-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty