Healthcare Provider Details

I. General information

NPI: 1336013119
Provider Name (Legal Business Name): RISE AND GROW THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 JOHNS CREEK PKWY STE E
SUWANEE GA
30024-9122
US

IV. Provider business mailing address

PO BOX 2977
TUCKER GA
30085-2977
US

V. Phone/Fax

Practice location:
  • Phone: 678-414-0281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LUKE LEWINSON
Title or Position: CEO
Credential:
Phone: 678-520-5979