Provider Demographics
NPI:1649528951
Name:THRIVE WELLNESS AND REHAB, P.L.L.C
Entity type:Organization
Organization Name:THRIVE WELLNESS AND REHAB, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:575-587-7061
Mailing Address - Street 1:103 LIVINGSTON LOOP
Mailing Address - Street 2:STE B-1
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9747
Mailing Address - Country:US
Mailing Address - Phone:575-587-7061
Mailing Address - Fax:915-493-8264
Practice Address - Street 1:103 LIVINGSTON LOOP
Practice Address - Street 2:STE B-1
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9747
Practice Address - Country:US
Practice Address - Phone:575-587-7061
Practice Address - Fax:915-493-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty