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General NPI Number Information
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NPI Number | 1649528951
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS AND REHAB, P.L.L.C
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 103 LIVINGSTON LOOP STE B-1
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City | SANTA TERESA
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State | NM
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Zip | 88008-9747
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Country | US
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Telephone | 575-587-7061
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Fax | 915-493-8264
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Provider Business Mailing Address
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Address Line | 103 LIVINGSTON LOOP STE B-1
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City | SANTA TERESA
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State | NM
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Zip | 88008-9747
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Country | US
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Telephone | 575-587-7061
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Fax | 915-493-8264
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL DAVID GONZALEZ
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Credential | PT
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Telephone | 575-587-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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