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General NPI Number Information
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NPI Number | 1205706314
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Entity Type | Organization
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Legal Business Name | THRIVE GENERATIONS THERAPY GROUP, LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 192 SOMERVILLE DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1108
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Country | US
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Telephone | 516-547-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 192 SOMERVILLE DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1108
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Country | US
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Telephone | 516-547-1203
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Fax |
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Authorized Official
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Title or Position | OWNER/OT
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Name | SAMANTHA GOTTLIEB
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Credential | OTR/L
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Telephone | 516-547-1203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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