Provider Demographics
NPI:1164243531
Name:THRIVE THERAPY
Entity type:Organization
Organization Name:THRIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLYZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-291-9659
Mailing Address - Street 1:107 YUCCA DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7126
Mailing Address - Country:US
Mailing Address - Phone:575-749-4348
Mailing Address - Fax:
Practice Address - Street 1:107 YUCCA DR
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7126
Practice Address - Country:US
Practice Address - Phone:575-749-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty