Provider Demographics
NPI:1962708883
Name:FORTIS THERAPY LLC
Entity type:Organization
Organization Name:FORTIS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-602-3295
Mailing Address - Street 1:4334 NW EXPRESSWAY STE 176
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1550
Mailing Address - Country:US
Mailing Address - Phone:405-602-3295
Mailing Address - Fax:405-602-3297
Practice Address - Street 1:4334 NW EXPRESSWAY STE 176
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1550
Practice Address - Country:US
Practice Address - Phone:405-602-3295
Practice Address - Fax:405-602-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health