Healthcare Provider Details

I. General information

NPI: 1053181834
Provider Name (Legal Business Name): THRIVE SPEECH & FEEDING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 W CARSON ST STE 100
TORRANCE CA
90503-6705
US

IV. Provider business mailing address

3858 W CARSON ST STE 100
TORRANCE CA
90503-6705
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1481
  • Fax: 424-251-5380
Mailing address:
  • Phone: 424-225-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ROSE K FAIRBAIRN
Title or Position: OWNER
Credential: SLP
Phone: 424-225-1481