Provider Demographics
NPI:1780217802
Name:RISE PELVIC THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:RISE PELVIC THERAPY & WELLNESS, LLC
Other - Org Name:OCCUPATIONAL THERAPY PELVIC WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMPH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:928-605-7070
Mailing Address - Street 1:2911 S RAINBOW AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3535
Mailing Address - Country:US
Mailing Address - Phone:612-963-2147
Mailing Address - Fax:
Practice Address - Street 1:1380 S CASTLE DOME AVE STE 104
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2024
Practice Address - Country:US
Practice Address - Phone:612-963-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty