Provider Demographics
NPI:1740887967
Name:NEURO THRIVE LLC
Entity type:Organization
Organization Name:NEURO THRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRINLEY
Authorized Official - Middle Name:NEFF
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-801-0023
Mailing Address - Street 1:1963 NE FELICITA PL
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5756
Mailing Address - Country:US
Mailing Address - Phone:561-801-0023
Mailing Address - Fax:
Practice Address - Street 1:1963 NE FELICITA PL
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5756
Practice Address - Country:US
Practice Address - Phone:561-801-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy