Provider Demographics
NPI:1578799094
Name:PHYSICAL THERAPY AT THRIVE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AT THRIVE, LLC
Other - Org Name:THRIVE PHYSICAL THERAPY AND PILATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-344-0737
Mailing Address - Street 1:2302 N BOGUS BASIN RD
Mailing Address - Street 2:STE. C
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0902
Mailing Address - Country:US
Mailing Address - Phone:208-344-0737
Mailing Address - Fax:208-344-0759
Practice Address - Street 1:2302 N BOGUS BASIN RD
Practice Address - Street 2:STE. C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0902
Practice Address - Country:US
Practice Address - Phone:208-344-0737
Practice Address - Fax:208-344-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-11372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807030700Medicaid
ID1655519Medicare PIN