Healthcare Provider Details

I. General information

NPI: 1295328706
Provider Name (Legal Business Name): RISE PHYSICAL THERAPY & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15314 CARROLLTON BLVD
CARROLLTON VA
23314-2304
US

IV. Provider business mailing address

9215 WIGNEIL ST
SUFFOLK VA
23433-1530
US

V. Phone/Fax

Practice location:
  • Phone: 757-650-2513
  • Fax:
Mailing address:
  • Phone: 757-650-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA RAE HAYNIE
Title or Position: CEO/DPT
Credential: DPT
Phone: 757-650-2513