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General NPI Number Information
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NPI Number | 1750252284
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Entity Type | Organization
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Legal Business Name | THRIVE SPORTS AND WELLNESS
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 5659 W 8TH ST UNIT 102
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City | LOS ANGELES
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State | CA
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Zip | 90036-4795
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Country | US
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Telephone | 818-620-0717
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Fax |
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Provider Business Mailing Address
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Address Line | 5659 W 8TH ST UNIT 102
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City | LOS ANGELES
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State | CA
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Zip | 90036-4795
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Country | US
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Telephone | 818-620-0717
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Fax |
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Authorized Official
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Title or Position | WELLNESS DIRECTOR
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Name | TROY M LEWIS
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Credential | PTA CSCS
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Telephone | 818-620-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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