Provider Demographics
NPI:1871117705
Name:LEVEL UP PHYSICAL THERAPY
Entity type:Organization
Organization Name:LEVEL UP PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, SPT
Authorized Official - Phone:808-347-1105
Mailing Address - Street 1:6420 SEMINOLE TRL STE L4
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2836
Mailing Address - Country:US
Mailing Address - Phone:808-347-1105
Mailing Address - Fax:
Practice Address - Street 1:6420 SEMINOLE TRL STE L4
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2836
Practice Address - Country:US
Practice Address - Phone:808-347-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty