Healthcare Provider Details

I. General information

NPI: 1346772803
Provider Name (Legal Business Name): RISE UP THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 W RIO VISTA AVE
TAMPA FL
33603-1119
US

IV. Provider business mailing address

1726 W RIO VISTA AVE
TAMPA FL
33603-1119
US

V. Phone/Fax

Practice location:
  • Phone: 813-810-0692
  • Fax: 866-201-2279
Mailing address:
  • Phone: 813-810-0692
  • Fax: 866-201-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CORINNE ZIMMERMAN
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 954-366-2700