=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538064597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOT & RISE THERAPY STUDIO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2026
-----------------------------------------------------
Last Update Date | 10/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 6TH AVE
-----------------------------------------------------
City | DE WITT
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52742-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-340-1224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 6TH AVE
-----------------------------------------------------
City | DE WITT
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52742-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-340-1224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | RACHEL THOMPSON
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 563-726-1882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------