Provider Demographics
NPI:1134125354
Name:RISING STAR THERAPY SPECIALIST, LCC
Entity Type:Organization
Organization Name:RISING STAR THERAPY SPECIALIST, LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-531-6306
Mailing Address - Street 1:10613 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3102
Mailing Address - Country:US
Mailing Address - Phone:602-955-9332
Mailing Address - Fax:602-531-6306
Practice Address - Street 1:10613 N 23RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3102
Practice Address - Country:US
Practice Address - Phone:602-955-9332
Practice Address - Fax:602-531-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty