Provider Demographics
NPI:1639426141
Name:RISE HOME THERAPY, LLC
Entity Type:Organization
Organization Name:RISE HOME THERAPY, LLC
Other - Org Name:BRIAN HOMAN, PT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:856-345-4830
Mailing Address - Street 1:82 PELICAN PLACE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086
Mailing Address - Country:US
Mailing Address - Phone:856-345-4830
Mailing Address - Fax:856-853-0769
Practice Address - Street 1:82 PELICAN PLACE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086
Practice Address - Country:US
Practice Address - Phone:856-345-4830
Practice Address - Fax:856-853-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA002741002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty