Provider Demographics
NPI:1841725785
Name:STRIVE PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Entity type:Organization
Organization Name:STRIVE PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, CERT MDT
Authorized Official - Phone:856-677-4000
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:80 S MAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7829
Practice Address - Country:US
Practice Address - Phone:856-500-3800
Practice Address - Fax:856-213-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty