Provider Demographics
NPI:1063941581
Name:ELEVATE PHYSICAL THERAPY AND REHABILITATION PC
Entity type:Organization
Organization Name:ELEVATE PHYSICAL THERAPY AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CANNISI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:516-359-8572
Mailing Address - Street 1:1940 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3608
Mailing Address - Country:US
Mailing Address - Phone:516-359-8572
Mailing Address - Fax:
Practice Address - Street 1:1940 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1712
Practice Address - Country:US
Practice Address - Phone:516-359-8572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty