Healthcare Provider Details

I. General information

NPI: 1417780222
Provider Name (Legal Business Name): RALLY TO RISE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 S 25TH E STE 104
AMMON ID
83406-5735
US

IV. Provider business mailing address

939 S 25TH E STE 104
AMMON ID
83406-5735
US

V. Phone/Fax

Practice location:
  • Phone: 208-715-8504
  • Fax: 208-715-8505
Mailing address:
  • Phone: 208-715-8504
  • Fax: 208-715-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MORGAN JESSE RICKS
Title or Position: CO-OWNER
Credential:
Phone: 208-715-8504