Provider Demographics
NPI:1629098181
Name:THRIVE PHYSICAL THERAPY INCORPORATED
Entity Type:Organization
Organization Name:THRIVE PHYSICAL THERAPY INCORPORATED
Other - Org Name:OPTIMAL SOLUTIONS PHYSICAL THERAPY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-320-2220
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DRIVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5556
Mailing Address - Country:US
Mailing Address - Phone:804-320-2220
Mailing Address - Fax:804-320-2226
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 520
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5556
Practice Address - Country:US
Practice Address - Phone:804-320-2220
Practice Address - Fax:804-320-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11034742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09284Medicare PIN