NPIMap

Organization Active NPI

Thrive Wellness and Rehab, P.L.L.C

  • Physical Therapist
  • Santa Teresa, NM
National Provider Identifier
1649528951
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
THRIVE WELLNESS AND REHAB, P.L.L.C
Practice address
103 Livingston Loop
Ste B-1
Santa Teresa, NM 88008-9747
Phone
(575) 587-7061
Fax
(915) 493-8264
NPI assigned
Aug 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel David Gonzalez, PTNPI 1780628271
Title
Owner
Phone
(575) 587-7061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

103 Livingston Loop
Ste B-1
Santa Teresa, NM 88008-9747

Mailing address

103 Livingston Loop
Ste B-1
Santa Teresa, NM 88008-9747
Phone (575) 587-7061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121002000661 NM Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4688823925 Receives reassigned benefits from 5 practitioners
Practice locations: Santa Teresa, NM; Chaparral, NM; Anthony, NM

National Provider Directory

National Provider Directory

Locations

459 Landers Rd
Anthony, NM 88021

1275 Anthony Dr
Ste 5
Anthony, NM 88021
Phone (575) 618-7867

103 Livingston Loop
Ste B1LP
Santa Teresa, NM 88008

103 Livingston Loop
Ste B1
Santa Teresa, NM 88008
Phone (575) 332-4246

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1649528951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 LIVINGSTON LOOP",
            "address_2": "STE B-1",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089747",
            "telephone_number": "575-587-7061",
            "fax_number": "915-493-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 LIVINGSTON LOOP",
            "address_2": "STE B-1",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089747",
            "telephone_number": "575-587-7061",
            "fax_number": "915-493-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE WELLNESS AND REHAB, P.L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-587-7061",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Teresa, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.