Provider Demographics
NPI:1124600440
Name:THRIVE PHYSIO AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:THRIVE PHYSIO AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:214-308-1698
Mailing Address - Street 1:125 N WINDOMERE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5331
Mailing Address - Country:US
Mailing Address - Phone:972-741-6632
Mailing Address - Fax:
Practice Address - Street 1:125 N WINDOMERE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5331
Practice Address - Country:US
Practice Address - Phone:972-741-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center