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General NPI Number Information
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NPI Number | 1699587980
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Entity Type | Organization
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Legal Business Name | THRIVE PLUS CONQUER PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 8336 MONROE ROAD SUITE 152
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City | LAMBERTVILLE
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State | MI
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Zip | 48144
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Country | US
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Telephone | 517-902-6224
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Fax |
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Provider Business Mailing Address
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Address Line | 8504 SANDRA KAY DR
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City | LAMBERTVILLE
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State | MI
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Zip | 48144-9673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARY ALEXANDER
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Credential |
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Telephone | 517-902-6224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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