MEDICARE: THRIVE PHYSICAL THERAPY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	1103474	VA

General Provider Information

NPI Number	:	1629098181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PHYSICAL THERAPY INCORPORATED

Provider Business Mailing Address
First Line	:	7400 BEAUFONT SPRINGS DRIVE
Second Line	:	SUITE 520
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5556
Country	:	US
Telephone Number	:	804-320-2220
Fax Number	:	804-320-2226

Provider Business Practice Location Address
First Line	:	7400 BEAUFONT SPRINGS DR
Second Line	:	SUITE 520
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5556
Country	:	US
Telephone Number	:	804-320-2220
Fax Number	:	804-320-2226

Authorized Official
Title or Position	:	PT
Name	:	MR. CHARLES CLARKE TANNER
Credential	:	PT.
Telephone Number	:	804-320-2220

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/10/2017

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