Provider Demographics
NPI:1275109464
Name:THRIVE PT & WELLNESS LLC
Entity Type:Organization
Organization Name:THRIVE PT & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:386-315-9455
Mailing Address - Street 1:80 RIVERVIEW BND S UNIT 811
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-6584
Mailing Address - Country:US
Mailing Address - Phone:386-315-9455
Mailing Address - Fax:
Practice Address - Street 1:80 RIVERVIEW BND S UNIT 811
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-6584
Practice Address - Country:US
Practice Address - Phone:386-315-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty