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General NPI Number Information
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NPI Number | 1396400818
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Entity Type | Organization
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Legal Business Name | NEUTHRIVE LLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 2314 MAIN ST
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City | GENOA
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State | NV
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Zip | 89411-1542
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Country | US
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Telephone | 775-790-3012
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Fax | 775-392-2266
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Provider Business Mailing Address
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Address Line | PO BOX 1335
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City | GENOA
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State | NV
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Zip | 89411-1335
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Country | US
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Telephone | 775-790-3012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TESS MARIE JANSSE
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Credential | PT
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Telephone | 775-790-3012
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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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