NPIMap

Organization Active NPI

Elevate Sports and Spine Physical Therapy, PLLC

  • Physical Therapist
  • Lacey, WA
National Provider Identifier
1184477283
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ELEVATE SPORTS AND SPINE PHYSICAL THERAPY, PLLC
Practice address
3201 Willamette Dr NE Ste C
Lacey, WA 98516-1376
Phone
(360) 888-8009
NPI assigned
Apr 9, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Zachary HallNPI 1649523903
Title
Owner
Phone
(360) 888-8009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Hand Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XH1200X

Addresses

Primary practice location

3201 Willamette Dr NE Ste C
Lacey, WA 98516-1376

Mailing address

941 G St SW
Tumwater, WA 98512-4602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240715000786 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4688119647 Receives reassigned benefits from 3 practitioners
Practice locations: Lacey, WA

National Provider Directory

National Provider Directory

Locations

3201 Willamette Dr NE
Ste C
Lacey, WA 98516
Phone (360) 455-0100

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1184477283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 G ST SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985124602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 WILLAMETTE DR NE STE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985161376",
            "telephone_number": "360-888-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE SPORTS AND SPINE PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-888-8009"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.