Provider Demographics
NPI:1740752849
Name:THRIVE VETERANS WELLNESS
Entity Type:Organization
Organization Name:THRIVE VETERANS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBERA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-347-1191
Mailing Address - Street 1:911 N BUFFALO DR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0380
Mailing Address - Country:US
Mailing Address - Phone:702-347-1191
Mailing Address - Fax:
Practice Address - Street 1:911 N BUFFALO DR UNIT 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0380
Practice Address - Country:US
Practice Address - Phone:702-347-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty