Provider Demographics
NPI:1205153848
Name:THRIVE PHYSICAL MEDICINE INC
Entity type:Organization
Organization Name:THRIVE PHYSICAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-757-0222
Mailing Address - Street 1:2741 VISTA WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6373
Mailing Address - Country:US
Mailing Address - Phone:760-757-0222
Mailing Address - Fax:760-757-0224
Practice Address - Street 1:2741 VISTA WAY STE 111
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6373
Practice Address - Country:US
Practice Address - Phone:760-757-0222
Practice Address - Fax:760-757-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9611208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty