Provider Demographics
NPI:1699470609
Name:RYSEUP REHAB LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:RYSEUP REHAB LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-449-0253
Mailing Address - Street 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:BLDG 5, STE B
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-449-0253
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:BLDG 5, STE B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-449-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty