Provider Demographics
NPI:1275002461
Name:THRIVETOTHRIVE, LLC
Entity Type:Organization
Organization Name:THRIVETOTHRIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-536-5667
Mailing Address - Street 1:8401 SARENSEN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3393
Mailing Address - Country:US
Mailing Address - Phone:910-536-5667
Mailing Address - Fax:877-688-3638
Practice Address - Street 1:1606 PHYSICIANS DRIVE
Practice Address - Street 2:INSIDE PROMINA HEALTH
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-859-4678
Practice Address - Fax:877-688-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588793210OtherINDIVIDUAL NPI OF OWNER
NCP6968OtherOWNER PT NC STATE LICENSE