Provider Demographics
NPI:1598294142
Name:RISE PHYSICAL THERAPY PRIME WELLNESS INC
Entity Type:Organization
Organization Name:RISE PHYSICAL THERAPY PRIME WELLNESS INC
Other - Org Name:RISE PRIME WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNANVASH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:503-453-4841
Mailing Address - Street 1:5550 CARMEL MOUNTAIN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4861
Mailing Address - Country:US
Mailing Address - Phone:503-453-4841
Mailing Address - Fax:
Practice Address - Street 1:5550 CARMEL MOUNTAIN RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4861
Practice Address - Country:US
Practice Address - Phone:503-453-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty