Provider Demographics
NPI:1700371408
Name:RISE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RISE PHYSICAL THERAPY
Other - Org Name:KINETIKCHAIN DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:573-528-2530
Mailing Address - Street 1:468 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1817
Mailing Address - Country:US
Mailing Address - Phone:573-528-2530
Mailing Address - Fax:
Practice Address - Street 1:121 S MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3019
Practice Address - Country:US
Practice Address - Phone:720-651-0674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1629389051Medicaid
CO0010821OtherCOLORADO LICENSE