Provider Demographics
NPI:1861964520
Name:ELEVATED PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ELEVATED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:MANASCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-364-1747
Mailing Address - Street 1:2347 TALL SAIL DR APT L
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6639
Mailing Address - Country:US
Mailing Address - Phone:843-364-1747
Mailing Address - Fax:
Practice Address - Street 1:44 MARKFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7908
Practice Address - Country:US
Practice Address - Phone:843-364-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy