Provider Demographics
NPI:1447944137
Name:ELEVATED PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:ELEVATED PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAUD-GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-313-8680
Mailing Address - Street 1:238 E BENTON RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910-6149
Mailing Address - Country:US
Mailing Address - Phone:207-313-8680
Mailing Address - Fax:
Practice Address - Street 1:238 E BENTON RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:ME
Practice Address - Zip Code:04910-6149
Practice Address - Country:US
Practice Address - Phone:207-313-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty