=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851170427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE RECOVERY AND PERFORMANCE CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2023
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3430 FAIRFIELD AVE S UNIT A
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33711-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-806-2055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 MASON LN APT 4112
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15205-5438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-605-7212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIA SACCUCCI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-806-2055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------