Provider Demographics
NPI:1821885963
Name:RISE & RESTORE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RISE & RESTORE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-340-8512
Mailing Address - Street 1:141 LA COSTA DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5542
Mailing Address - Country:US
Mailing Address - Phone:856-344-3203
Mailing Address - Fax:
Practice Address - Street 1:141 LA COSTA DR
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-5542
Practice Address - Country:US
Practice Address - Phone:856-344-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty