Provider Demographics
NPI:1851141626
Name:RISE & SHINE PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:RISE & SHINE PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:912-237-1638
Mailing Address - Street 1:10735 GA HIGHWAY 242
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:GA
Mailing Address - Zip Code:31035-7346
Mailing Address - Country:US
Mailing Address - Phone:912-237-1638
Mailing Address - Fax:
Practice Address - Street 1:303 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-2668
Practice Address - Country:US
Practice Address - Phone:912-237-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty