Healthcare Provider Details

I. General information

NPI: 1144095860
Provider Name (Legal Business Name): RISE PEDIATRIC THERAPIES QUEEN CREEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8743 E PECOS RD STE 110
MESA AZ
85212-9303
US

IV. Provider business mailing address

4554 E INVERNESS AVE
MESA AZ
85206-4639
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RYAN COZZOLINO
Title or Position: COO
Credential:
Phone: 480-389-4516