Provider Demographics
NPI:1952084014
Name:UPRISE PHYSICAL THERAPY AND PERFORMANCE
Entity type:Organization
Organization Name:UPRISE PHYSICAL THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:410-491-4263
Mailing Address - Street 1:7135 MILL RUN DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1208
Mailing Address - Country:US
Mailing Address - Phone:410-491-4263
Mailing Address - Fax:
Practice Address - Street 1:7135 MILL RUN DR
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1208
Practice Address - Country:US
Practice Address - Phone:410-491-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty