Healthcare Provider Details

I. General information

NPI: 1821445636
Provider Name (Legal Business Name): RISE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 E PALMER WASILLA HWY STE 230
WASILLA AK
99654-7289
US

IV. Provider business mailing address

PO BOX 873895
WASILLA AK
99687-3895
US

V. Phone/Fax

Practice location:
  • Phone: 907-312-7044
  • Fax: 907-312-7044
Mailing address:
  • Phone: 907-205-5945
  • Fax: 907-205-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASEY BUCKLAND
Title or Position: OWNER
Credential: PT, DPT, ECS
Phone: 480-205-5945