Healthcare Provider Details

I. General information

NPI: 1629444278
Provider Name (Legal Business Name): THRIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 ACADEMY PARKWAY SOUTH NE
ALBUQUERQUE NM
87109-4410
US

IV. Provider business mailing address

3811 ACADEMY PARKWAY SOUTH NE
ALBUQUERQUE NM
87109-4410
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON MCDERMOTT
Title or Position: PRESIDENT
Credential:
Phone: 505-401-2820