Healthcare Provider Details

I. General information

NPI: 1518540525
Provider Name (Legal Business Name): RISE PERFORMANCE & HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 MINOR AVE E APT 102
SEATTLE WA
98102-3533
US

IV. Provider business mailing address

2034 MINOR AVE E APT 102
SEATTLE WA
98102-3533
US

V. Phone/Fax

Practice location:
  • Phone: 509-969-2324
  • Fax:
Mailing address:
  • Phone: 509-969-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE LYNNE IRWIN
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT, OCS, FAAOMPT
Phone: 509-969-2324