Healthcare Provider Details

I. General information

NPI: 1013731728
Provider Name (Legal Business Name): RISE UP PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 OCEAN AVE APT 2F
BROOKLYN NY
11229-3560
US

IV. Provider business mailing address

24 KASTAL DR
RIDGE NY
11961-1932
US

V. Phone/Fax

Practice location:
  • Phone: 347-352-2204
  • Fax: 929-473-2327
Mailing address:
  • Phone: 347-352-2204
  • Fax: 929-473-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PEABRO CANDO
Title or Position: OWNER
Credential: DPT
Phone: 347-352-2204