Provider Demographics
NPI:1760128672
Name:THRIVE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:THRIVE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MSC, NCS
Authorized Official - Phone:229-262-4075
Mailing Address - Street 1:111 WOODROW WILSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2583
Mailing Address - Country:US
Mailing Address - Phone:229-262-4075
Mailing Address - Fax:229-262-4076
Practice Address - Street 1:111 WOODROW WILSON DR STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2583
Practice Address - Country:US
Practice Address - Phone:229-262-4075
Practice Address - Fax:229-262-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty