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General NPI Number Information
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NPI Number | 1386141752
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Entity Type | Organization
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Legal Business Name | THRIVE PT LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 3901 NATIONAL DR STE 100
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1176
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Country | US
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Telephone | 301-421-1125
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Fax | 301-500-2175
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | BURTONSVILLE
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State | MD
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Zip | 20866-0356
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Country | US
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Telephone | 301-421-1125
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Fax | 301-500-2175
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | ALISHA M MARTIN
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Credential |
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Telephone | 301-421-1125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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