Elevate Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ELEVATE PHYSICAL THERAPY

Practice address

7701 NE Highway 99 Ste 109
Vancouver, WA 98665-8871

Phone

(360) 605-0416

Fax

(360) 605-0417

NPI assigned

Aug 23, 2019

Organization subpart

No

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

Authorized official

Name

Greggory Mortensen

Title

Owner/Physical Therapist

Phone

(360) 605-0416

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1245887272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7701 NE HIGHWAY 99 STE 109",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658871",
            "telephone_number": "360-605-0416",
            "fax_number": "360-605-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 NE HIGHWAY 99 STE 109",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658871",
            "telephone_number": "360-605-0416",
            "fax_number": "360-605-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-23",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "GREGGORY",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "360-605-0416"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE LICENSE",
            "identifier": "PT-60735053",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OR STATE LICENSE",
            "identifier": "61158",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Vancouver, WA
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• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.