Provider Demographics
NPI:1699227009
Name:THRIVE PROSTHETICS
Entity Type:Organization
Organization Name:THRIVE PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDINET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-677-5770
Mailing Address - Street 1:6600 COYLE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6344
Mailing Address - Country:US
Mailing Address - Phone:916-671-3417
Mailing Address - Fax:916-241-9344
Practice Address - Street 1:6600 COYLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6344
Practice Address - Country:US
Practice Address - Phone:916-671-3417
Practice Address - Fax:916-241-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier