1629098181 NPI number — THRIVE PHYSICAL THERAPY INCORPORATED

Table of content: JULIANNE R. KNOWLES OD (NPI 1881767499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629098181 NPI number — THRIVE PHYSICAL THERAPY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVE PHYSICAL THERAPY INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629098181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 BEAUFONT SPRINGS DR
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
NORTH CHESTERFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23225-5556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-320-2220
Provider Business Practice Location Address Fax Number:
804-320-2226
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TANNER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
CLARKE
Authorized Official Title or Position:
PT
Authorized Official Telephone Number:
804-320-2220

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  1103474 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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