Healthcare Provider Details

I. General information

NPI: 1669818035
Provider Name (Legal Business Name): RISE EARLY INTERVENTION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4554 E INVERNESS AVE STE C3
MESA AZ
85206-4639
US

IV. Provider business mailing address

4554 E INVERNESS AVE STE C3
MESA AZ
85206-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-295-4925
  • Fax: 480-497-4756
Mailing address:
  • Phone: 480-295-4925
  • Fax: 480-497-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTIN MANCUSO
Title or Position: CHIEF OPERATING OFFICER
Credential: PT DPT
Phone: 480-295-4958