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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