Elevate Rehab, LLC
Organization Active NPI Physical Medicine & Rehabilitation Physician · Lander, WY
NPI 1003257601 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1003257601
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- ELEVATE REHAB, LLC
- Practice address
- 545 E Main St Ste B
Lander, WY 82520-3470 - Phone
- (307) 335-3471
- Fax
- (307) 332-5388
- NPI assigned
- Jul 11, 2013
- Organization subpart
- No
Authorized official
- Name
- Michelle L Mazur
- Title
- Owner
- Phone
- (307) 335-3471
Practitioners 10
-
Michelle L Mazur, OT
-
Ryan Flatt, PT, DPT
-
Sarah Flatt, DPT
-
Courtney L Hansen, MPT
-
Theresa Shoemaker, PT, DPT
-
Katelin Renee Tucker, PT, DPT, CERT MDT
-
Laura Varner, OTR/L, CHT
-
Katherine Quayle, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131014000145 | WY | Part B Supplier - Clinic/Group Practice | 4981838687 |
Receives reassigned benefits from 9 practitioners Practice locations: Lander, WY |
| O20151023000826 | WY | DME Supplier - Independently-Practicing Occupational Therapist | 4981838687 | Practice locations: Lander, WY |
National Provider Directory
Locations
155 S 6th St
Lander, WY 82520
Phone (307) 335-3471
535 E Main St
Ste D
Lander, WY 82520
Phone (307) 335-3471
545 E Main St
#B
Lander, WY 82520
Phone (307) 335-3471
388 Main St
Ste A
Lander, WY 82520
Phone (307) 335-3471
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes | ||
| Physical Therapy Clinic/Center | 261QP2000X | |||
| Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | |||
| Customized Equipment (DME) | 332BC3200X |
Addresses
Primary practice location
545 E Main St Ste B
Lander, WY 82520-3470
Mailing address
545 E Main St Ste B
Lander, WY 82520-3470
Phone (307) 335-3471
Other providers in Lander, WY
- Margaret Ann Easley
- Wendy Marie Eaton
- Eh Health Home Health of the Northwest, LLC
- Eh Hospice of the West, LLC
- Jessika Eiskant
- Ashlee Anne Eller
- Deborah S Ellsworth
- Joy Lynn Erickson
- Christopher Harold Erschen
- Donna Karen Estep
All providers in Lander, WY · Physical Medicine & Rehabilitation Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.