=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336765403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE THERAPY SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2020
-----------------------------------------------------
Last Update Date | 06/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 N MAIN ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72576-9473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-307-4383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 GOINGS RIDGE RD
-----------------------------------------------------
City | HARDY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72542-8810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-307-4383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPTA/OWNER
-----------------------------------------------------
Name | SANDI HARDIN
-----------------------------------------------------
Credential | LPTA
-----------------------------------------------------
Telephone | 870-307-4383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------