Provider Demographics
NPI:1982123196
Name:RISE PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:RISE PEDIATRIC THERAPY LLC
Other - Org Name:RISE PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:720-602-0384
Mailing Address - Street 1:5610 WARD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1309
Mailing Address - Country:US
Mailing Address - Phone:720-602-0384
Mailing Address - Fax:
Practice Address - Street 1:5610 WARD RD STE 300
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1309
Practice Address - Country:US
Practice Address - Phone:719-660-8592
Practice Address - Fax:720-602-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty