Healthcare Provider Details
I. General information
NPI: 1699573204
Provider Name (Legal Business Name): WE THRIVE MD
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/07/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3510 DR MARTIN LUTHER KING BLVD # 3
FORT MYERS FL
33916-4608
US
IV. Provider business mailing address
12653 ASTOR PL
FORT MYERS FL
33913-2603
US
V. Phone/Fax
- Phone: 239-402-8668
- Fax: 239-310-2850
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261Q00000X |
| Taxonomy | Clinic/Center |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QC1500X |
| Taxonomy | Community Health Clinic/Center |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QC1800X |
| Taxonomy | Corporate Health Clinic/Center |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP2300X |
| Taxonomy | Primary Care Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ALYSON
LEWIS
SANCHIOUS
Title or Position: CEO
Credential: MD
Phone: 239-402-8668