Provider Demographics
NPI:1023609799
Name:THRIVE HQ
Entity type:Organization
Organization Name:THRIVE HQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HIRN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:715-432-3608
Mailing Address - Street 1:10721 39TH ST N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-4468
Mailing Address - Country:US
Mailing Address - Phone:715-432-3608
Mailing Address - Fax:
Practice Address - Street 1:3511 LAKE ELMO AVE N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8484
Practice Address - Country:US
Practice Address - Phone:651-383-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy