Provider Demographics
NPI:1518579408
Name:FOCUS FORWARD THERAPY, LLC
Entity Type:Organization
Organization Name:FOCUS FORWARD THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-480-3011
Mailing Address - Street 1:3848 LEXMARK LN UNIT 403
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5226
Mailing Address - Country:US
Mailing Address - Phone:321-480-3011
Mailing Address - Fax:
Practice Address - Street 1:3848 LEXMARK LN UNIT 403
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5226
Practice Address - Country:US
Practice Address - Phone:321-480-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty