Provider Demographics
NPI:1225284565
Name:THRIVE IN MINDBODYSPIRIT, LLC
Entity Type:Organization
Organization Name:THRIVE IN MINDBODYSPIRIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/ ADMISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-713-6118
Mailing Address - Street 1:1120 S FEDERAL HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1231
Mailing Address - Country:US
Mailing Address - Phone:954-713-6118
Mailing Address - Fax:
Practice Address - Street 1:1120 S FEDERAL HWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1231
Practice Address - Country:US
Practice Address - Phone:954-719-6118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty