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General NPI Number Information
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NPI Number | 1659026839
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Entity Type | Organization
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Legal Business Name | THRIVE PEDIATRIC THERAPY
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 3 PINECREST DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4560
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Country | US
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Telephone | 479-567-5362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 722
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-0722
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Country | US
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Telephone | 479-414-6872
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DARA LEAVELL
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Credential |
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Telephone | 479-414-6872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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