Provider Demographics
NPI:1821445636
Name:RISE DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:RISE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-205-5945
Mailing Address - Street 1:PO BOX 873895
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-3895
Mailing Address - Country:US
Mailing Address - Phone:907-205-5945
Mailing Address - Fax:907-205-5948
Practice Address - Street 1:1981 E PALMER WASILLA HWY STE 230
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7289
Practice Address - Country:US
Practice Address - Phone:907-312-7044
Practice Address - Fax:907-312-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1651741Medicaid