Thrive Spa

Primary specialty

NutritionistTaxonomy code 133N00000X

License

PS35134 Issued in FL

Legal business name

THRIVE SPA

Doing business as

ThriveX

Practice address

2166 Wilton Dr
Wilton Manors, FL 33305-2107

Phone

(954) 441-4244

NPI assigned

Nov 18, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Mary Van, PHARM D, DACBN

Title

Director of Operations

Phone

(954) 557-7401

Specialties & licenses 3

Addresses

Other names 1

• ThriveX Doing business as

Locations

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1396288635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 WILTON DR",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333052107",
            "telephone_number": "954-441-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 WILTON DR",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333052107",
            "telephone_number": "954-441-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "VAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "954-557-7401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D, DACBN"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": "FL",
            "license": "PS35134",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME83875",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104055",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThriveX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nutritionist in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Nutritionist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.