Provider Demographics
NPI:1780195511
Name:RISE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:RISE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMOHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-634-4750
Mailing Address - Street 1:362 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4673
Mailing Address - Country:US
Mailing Address - Phone:347-634-4750
Mailing Address - Fax:347-227-8846
Practice Address - Street 1:362 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4673
Practice Address - Country:US
Practice Address - Phone:347-634-4750
Practice Address - Fax:347-227-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040033225100000X
261QP2000X
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
NY06254439Medicaid