Provider Demographics
NPI:1053181834
Name:THRIVE SPEECH & FEEDING THERAPY
Entity type:Organization
Organization Name:THRIVE SPEECH & FEEDING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAIRBAIRN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:424-225-1481
Mailing Address - Street 1:3858 W CARSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6705
Mailing Address - Country:US
Mailing Address - Phone:424-225-1481
Mailing Address - Fax:
Practice Address - Street 1:3858 W CARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6705
Practice Address - Country:US
Practice Address - Phone:424-225-1481
Practice Address - Fax:424-251-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty