Provider Demographics
NPI:1891202487
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:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-343-4641
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-0101
Mailing Address - Country:US
Mailing Address - Phone:970-343-4641
Mailing Address - Fax:970-360-1124
Practice Address - Street 1:202 8TH ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3306
Practice Address - Country:US
Practice Address - Phone:970-343-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9679261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy