Healthcare Provider Details

I. General information

NPI: 1356208680
Provider Name (Legal Business Name): FORM TO THRIVE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 ANNA CIR
WEBSTER NY
14580-9685
US

IV. Provider business mailing address

365 ANNA CIR
WEBSTER NY
14580-9685
US

V. Phone/Fax

Practice location:
  • Phone: 631-682-6778
  • 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: SEAN DAVEY
Title or Position: SOLE MEMBER
Credential: DPT
Phone: 631-682-6778