Organization
ELEVATE PHYSICAL THERAPY & PAIN CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HERBERT BLAKELY DPT, OCS (OWNER/PHYSICAL THERAPIST)
(828) 342-7358
Entity
Organization
Contact information
Practice address
4 MARKET ST, SUITE 4103, BREVARD, NC 28712-5635
(828) 877-2110
Mailing address
4 MARKET ST STE 4103, BREVARD, NC 28712-5636
(828) 342-7358
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7217
NC
225100000X
Physical Therapist
8721
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078RC
BLUE CROSS BLUE SHIELD
NC
01
—
078RG
BLUE CROSS BLUE SHIELD
NC
05
—
7211277
—
NC
05
—
7211281
—
NC
01
—
B8363
MEDCOST
NC
01
—
B8364
MEDCOST
NC
Enumeration date
10/16/2012
Last updated
09/30/2020
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