Provider Demographics
NPI:1083038764
Name:RISE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RISE PHYSICAL THERAPY INC
Other - Org Name:SILVER STRAND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNANVASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CSCS, FAFS
Authorized Official - Phone:503-453-4841
Mailing Address - Street 1:380 STEVENS AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2063
Mailing Address - Country:US
Mailing Address - Phone:858-755-5200
Mailing Address - Fax:858-755-5201
Practice Address - Street 1:380 STEVENS AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2063
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:858-755-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38257225100000X, 2251G0304X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty