Provider Demographics
NPI:1851743009
Name:RISE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:RISE PHYSICAL THERAPY, INC.
Other - Org Name:RISE PHYSICAL THERAPY, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:479-747-0001
Mailing Address - Street 1:2668 E CITIZENS DR STE 5
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4796
Mailing Address - Country:US
Mailing Address - Phone:479-442-7473
Mailing Address - Fax:479-239-5444
Practice Address - Street 1:2668 E CITIZENS DR STE 5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-442-7473
Practice Address - Fax:844-809-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 261QP2000X
AR3374261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy