Provider Demographics
NPI:1114698511
Name:THRIVE PELVIC HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:THRIVE PELVIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEAGY
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:814-282-4903
Mailing Address - Street 1:9661 KRIDER RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6413
Mailing Address - Country:US
Mailing Address - Phone:814-282-4903
Mailing Address - Fax:
Practice Address - Street 1:11018 STATE HIGHWAY 18 STE 4
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-3556
Practice Address - Country:US
Practice Address - Phone:814-282-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center