Provider Demographics
NPI:1285007625
Name:THRIVE PEDIATRIC THERAPY GROUP
Entity Type:Organization
Organization Name:THRIVE PEDIATRIC THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:404-867-1682
Mailing Address - Street 1:1596 CLEVELAND AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3205
Mailing Address - Country:US
Mailing Address - Phone:404-975-3080
Mailing Address - Fax:888-886-0460
Practice Address - Street 1:1596 CLEVELAND AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3205
Practice Address - Country:US
Practice Address - Phone:404-975-3080
Practice Address - Fax:888-886-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005342235Z00000X
GASLP004848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty