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General NPI Number Information
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NPI Number | 1447807615
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Entity Type | Organization
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Legal Business Name | RISE UP REHAB, LLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 1687 OLD HWY 90
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City | CASTROVILLE
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State | TX
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Zip | 78009
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Country | US
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Telephone | 210-724-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 16400 BLANCO RD
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1902
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Country | US
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Telephone | 210-724-0505
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIFFANY DIXON GOLD
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Credential | OT
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Telephone | 210-724-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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