Healthcare Provider Details

I. General information

NPI: 1205706314
Provider Name (Legal Business Name): THRIVE GENERATIONS THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 SOMERVILLE DR
PONTE VEDRA FL
32081-1108
US

IV. Provider business mailing address

192 SOMERVILLE DR
PONTE VEDRA FL
32081-1108
US

V. Phone/Fax

Practice location:
  • Phone: 516-547-1203
  • Fax:
Mailing address:
  • Phone: 516-547-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA GOTTLIEB
Title or Position: OWNER/OT
Credential: OTR/L
Phone: 516-547-1203