Healthcare Provider Details

I. General information

NPI: 1619808847
Provider Name (Legal Business Name): THRIVE & RISE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13172 GREEN VIOLET DR
RIVERVIEW FL
33579-7214
US

IV. Provider business mailing address

13172 GREEN VIOLET DR
RIVERVIEW FL
33579-7214
US

V. Phone/Fax

Practice location:
  • Phone: 813-453-6467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA C GOMEZ
Title or Position: CEO
Credential: MSOT, OTR/L
Phone: 813-453-6467