Provider Demographics
NPI:1912636325
Name:RISE AGAIN PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RISE AGAIN PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-853-3448
Mailing Address - Street 1:13900 MARQUESAS WAY APT 5117
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6064
Mailing Address - Country:US
Mailing Address - Phone:310-853-3448
Mailing Address - Fax:310-881-9222
Practice Address - Street 1:8405 PERSHING DR STE 206
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7860
Practice Address - Country:US
Practice Address - Phone:310-853-3448
Practice Address - Fax:310-881-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy