NPIMap

Organization Active NPI

Level Up Wellness and Physical Therapy, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Oakland, CA
National Provider Identifier
1710659974
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
LEVEL UP WELLNESS AND PHYSICAL THERAPY, INC.
Practice address
3645 Grand Ave Ste 203
Oakland, CA 94610-2039
Phone
(510) 883-3534
Fax
(510) 255-6890
NPI assigned
Oct 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Authorized official

Name
Kristin OvertonNPI 1427509371
Title
Owner
Phone
(510) 883-3534

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

3645 Grand Ave Ste 203
Oakland, CA 94610-2039

Mailing address

3645 Grand Ave Ste 203
Oakland, CA 94610-2039
Phone (510) 883-3534

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220415000351 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0840686093 Receives reassigned benefits from 8 practitioners
Practice locations: Oakland, CA

National Provider Directory

National Provider Directory

Locations

3645 Grand Ave
Ste 203
Oakland, CA 94610
Phone (408) 504-6045

Practitioners & affiliated clinicians

Practitioners 10

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": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1710659974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3645 GRAND AVE STE 203",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946102039",
            "telephone_number": "510-883-3534",
            "fax_number": "510-255-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3645 GRAND AVE STE 203",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946102039",
            "telephone_number": "510-883-3534",
            "fax_number": "510-255-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEVEL UP WELLNESS AND PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "OVERTON",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-883-3534"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.