MEDICARE: THRIVE PERFORMANCE PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1902420722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PERFORMANCE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	2303 DENHAM DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8414
Country	:	US
Telephone Number	:	214-519-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 DENHAM DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8414
Country	:	US
Telephone Number	:	214-519-3992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL ERICKSON
Credential	:
Telephone Number	:	214-519-3992

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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