Healthcare Provider Details

I. General information

NPI: 1497937528
Provider Name (Legal Business Name): THRIVE INTEGRATED PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BROADWAY #503
NEW YORK NY
10012-2608
US

IV. Provider business mailing address

611 BROADWAY #503
NEW YORK NY
10012-2608
US

V. Phone/Fax

Practice location:
  • Phone: 212-254-7750
  • Fax: 212-254-1202
Mailing address:
  • Phone: 212-254-7750
  • Fax: 212-254-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number009326-1
License Number StateNY

VIII. Authorized Official

Name: RENA AMITAY
Title or Position: GENERAL MANAGER
Credential:
Phone: 212-254-7750