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General NPI Number Information
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NPI Number | 1295328706
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Entity Type | Organization
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Legal Business Name | RISE PHYSICAL THERAPY & WELLNESS, PLLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 15314 CARROLLTON BLVD
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City | CARROLLTON
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State | VA
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Zip | 23314-2304
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Country | US
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Telephone | 757-650-2513
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Fax |
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Provider Business Mailing Address
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Address Line | 9215 WIGNEIL ST
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City | SUFFOLK
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State | VA
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Zip | 23433-1530
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Country | US
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Telephone | 757-650-2513
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Fax |
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Authorized Official
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Title or Position | CEO/DPT
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Name | DR. JESSICA RAE HAYNIE
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Credential | DPT
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Telephone | 757-650-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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