Healthcare Provider Details

I. General information

NPI: 1295564490
Provider Name (Legal Business Name): THRIVE PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 SAN JOSE BLVD
JACKSONVILLE FL
32207-6060
US

IV. Provider business mailing address

3965 SAN JOSE BLVD
JACKSONVILLE FL
32207-6060
US

V. Phone/Fax

Practice location:
  • Phone: 904-613-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CABLE
Title or Position: OWNER, MANAGING DIRECTOR
Credential: OT/L
Phone: 904-315-7373