Provider Demographics
NPI:1417504879
Name:RISE UP REHAB, LLC
Entity Type:Organization
Organization Name:RISE UP REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:210-724-0505
Mailing Address - Street 1:16400 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1902
Mailing Address - Country:US
Mailing Address - Phone:210-724-0505
Mailing Address - Fax:
Practice Address - Street 1:5962 DANNY KAYE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5221
Practice Address - Country:US
Practice Address - Phone:210-724-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)