Provider Demographics
NPI:1992467732
Name:THRIVE AGING AND WELLNESS
Entity Type:Organization
Organization Name:THRIVE AGING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECATES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, GCS
Authorized Official - Phone:216-570-4027
Mailing Address - Street 1:240 FOX HOLLOW DR APT 210
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 FOX HOLLOW DR APT 210
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6104
Practice Address - Country:US
Practice Address - Phone:216-570-4027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty