Provider Demographics
NPI:1396400818
Name:NEUTHRIVE LLC
Entity Type:Organization
Organization Name:NEUTHRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JANSSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-790-3012
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NV
Mailing Address - Zip Code:89411-1335
Mailing Address - Country:US
Mailing Address - Phone:775-790-3012
Mailing Address - Fax:
Practice Address - Street 1:2314 MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NV
Practice Address - Zip Code:89411-1542
Practice Address - Country:US
Practice Address - Phone:775-790-3012
Practice Address - Fax:775-392-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy