MEDICARE: THRIVE THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1841878444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 481
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-0481
Country	:	US
Telephone Number	:	913-575-3697
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 APOLLO ST
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9611
Country	:	US
Telephone Number	:	913-575-3697
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	GENA ROSSOW
Credential	:	CCC-SLP
Telephone Number	:	913-575-3697

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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Directions to “THRIVE THERAPY, LLC ” Practice Location

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