Healthcare Provider Details

I. General information

NPI: 1275002461
Provider Name (Legal Business Name): THRIVETOTHRIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 PHYSICIANS DRIVE INSIDE PROMINA HEALTH
WILMINGTON NC
28401
US

IV. Provider business mailing address

8401 SARENSEN CT
WILMINGTON NC
28412-3393
US

V. Phone/Fax

Practice location:
  • Phone: 910-859-4678
  • Fax: 877-688-3638
Mailing address:
  • Phone: 910-536-5667
  • Fax: 877-688-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JON DUPLESSIS
Title or Position: OWNER/MANAGER
Credential: PT
Phone: 910-536-5667