Organization
THRIVE 3 21
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY MARGARETH CAVERO (MEDICAL TECHNOLOGIST)
(813) 784-1711
Entity
Organization
Contact information
Practice address
3262 MOONLIT LILY PL, BRANDON, FL 33511-7649
(813) 784-1711
Mailing address
3262 MOONLIT LILY PL, BRANDON, FL 33511-7649
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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