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General NPI Number Information
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NPI Number | 1164243531
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Entity Type | Organization
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Legal Business Name | THRIVE THERAPY
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 107 YUCCA DR
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City | PORTALES
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State | NM
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Zip | 88130-7126
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Country | US
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Telephone | 575-749-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 107 YUCCA DR
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City | PORTALES
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State | NM
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Zip | 88130-7126
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Country | US
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Telephone | 575-749-4348
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Fax |
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Authorized Official
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Title or Position | CREDENTIALLING MANAGER
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Name | TERESA BLYZE
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Credential |
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Telephone | 575-291-9659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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