Healthcare Provider Details

I. General information

NPI: 1538064597
Provider Name (Legal Business Name): ROOT & RISE THERAPY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 6TH AVE
DE WITT IA
52742-1329
US

IV. Provider business mailing address

802 6TH AVE
DE WITT IA
52742-1329
US

V. Phone/Fax

Practice location:
  • Phone: 563-340-1224
  • Fax:
Mailing address:
  • Phone: 563-340-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: RACHEL THOMPSON
Title or Position: CO-OWNER
Credential: OTR/L
Phone: 563-726-1882