Provider Demographics
NPI:1972197176
Name:ELEVATE PHYSIO PT NYC PC
Entity type:Organization
Organization Name:ELEVATE PHYSIO PT NYC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-587-9295
Mailing Address - Street 1:141 KINGSLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5102
Mailing Address - Country:US
Mailing Address - Phone:347-587-9205
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:141 KINGSLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5102
Practice Address - Country:US
Practice Address - Phone:347-587-9205
Practice Address - Fax:212-223-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty