Provider Demographics
NPI:1386253516
Name:RISE UP REHAB PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:RISE UP REHAB PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEABRO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-558-4474
Mailing Address - Street 1:24 KASTAL DR
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1932
Mailing Address - Country:US
Mailing Address - Phone:347-352-2204
Mailing Address - Fax:929-473-2327
Practice Address - Street 1:2827 OCEAN PKWY APT 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7853
Practice Address - Country:US
Practice Address - Phone:347-352-2204
Practice Address - Fax:929-473-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty