Organization
THRIVE SPA
Active
Organization
THRIVE SPA
Active
Other names
ThriveX
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY VAN PHARM D, DACBN (DIRECTOR OF OPERATIONS)
(954) 557-7401
Entity
Organization
Contact information
Practice address
2166 WILTON DR, WILTON MANORS, FL 33305-2107
(954) 441-4244
Mailing address
2166 WILTON DR, WILTON MANORS, FL 33305-2107
(954) 441-4244
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
PS35134
FL
208100000X
Physical Medicine & Rehabilitation Physician
ME83875
FL
363A00000X
Physician Assistant
PA9104055
FL
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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