Healthcare Provider Details

I. General information

NPI: 1023757077
Provider Name (Legal Business Name): THRIVE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 14TH ST
WINNER SD
57580-2514
US

IV. Provider business mailing address

510 W 14TH ST
WINNER SD
57580-2514
US

V. Phone/Fax

Practice location:
  • Phone: 605-840-9802
  • Fax:
Mailing address:
  • Phone: 605-840-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA NOVOTNY
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 605-840-9802