=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114486545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARISE ANEW THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2019
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2732 INDIAN PEAKS PL
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80526-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-330-4576
-----------------------------------------------------
Fax | 970-632-2994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2732 INDIAN PEAKS PL
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80526-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-330-4576
-----------------------------------------------------
Fax | 970-632-2994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/EMPLOYEE
-----------------------------------------------------
Name | ALICIA ANN SILBERNAGEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-330-4576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------