Basic Information
| Provider Information | |||||||||
| NPI: | 1598294142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RISE PHYSICAL THERAPY PRIME WELLNESS INC | ||||||||
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| OtherOrganizationName: | RISE PRIME WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5550 CARMEL MOUNTAIN RD STE 208 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921304861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034534841 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5550 CARMEL MOUNTAIN RD STE 208 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921304861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034534841 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HANNANVASH | ||||||||
| AuthorizedOfficialFirstName: | NAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5034534841 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.