Healthcare Provider Details

I. General information

NPI: 1295499531
Provider Name (Legal Business Name): THRIVE MOBILE PT & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 KEOWEE SCHOOL RD UNIT C
SENECA SC
29672-6779
US

IV. Provider business mailing address

114 KEOWEE SCHOOL RD UNIT C
SENECA SC
29672-6779
US

V. Phone/Fax

Practice location:
  • Phone: 864-539-2204
  • Fax: 855-344-5560
Mailing address:
  • Phone: 864-539-2204
  • Fax: 855-344-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARLENA REIF
Title or Position: OWNER
Credential: PT, DPT
Phone: 864-539-2204