Provider Demographics
NPI:1710345293
Name:THRIVE PROACTIVE HEALTH
Entity Type:Organization
Organization Name:THRIVE PROACTIVE HEALTH
Other - Org Name:THRIVE PROACTIVE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:757-416-6700
Mailing Address - Street 1:1340 N GREAT NECK RD
Mailing Address - Street 2:#1272-182
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2268
Mailing Address - Country:US
Mailing Address - Phone:757-416-6700
Mailing Address - Fax:757-416-7777
Practice Address - Street 1:2830 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7614
Practice Address - Country:US
Practice Address - Phone:757-416-6700
Practice Address - Fax:757-416-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052040002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty