Provider Demographics
NPI:1194549105
Name:ELEVATION PHYSICAL THERAPY & PERFORMANCE PLLC MAURICE DISLEY SOLE MBR
Entity type:Organization
Organization Name:ELEVATION PHYSICAL THERAPY & PERFORMANCE PLLC MAURICE DISLEY SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DISLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:413-285-4015
Mailing Address - Street 1:58 BURNETT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-3312
Mailing Address - Country:US
Mailing Address - Phone:413-285-4015
Mailing Address - Fax:
Practice Address - Street 1:340 MCKINSTRY AVE STE 250
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1849
Practice Address - Country:US
Practice Address - Phone:413-285-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy