Provider Demographics
NPI:1073104303
Name:STRIVE2LIVEWELL, LLC
Entity Type:Organization
Organization Name:STRIVE2LIVEWELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:MYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:732-618-7010
Mailing Address - Street 1:11 PEQUOT CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1296
Mailing Address - Country:US
Mailing Address - Phone:732-618-7010
Mailing Address - Fax:
Practice Address - Street 1:216 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1809
Practice Address - Country:US
Practice Address - Phone:732-618-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007907OtherPHYSICAL THERAPY LICENSE