Basic Information
| Provider Information | |||||||||
| NPI: | 1801550504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J KRU THERAPY LLC DBA FOCUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4997 ROYAL GULF CIR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339667006 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9961 INTERSTATE COMMERCE DR UNIT 150160 | ||||||||
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| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339138264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393135049 | ||||||||
| FaxNumber: | 2393135712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | VOLTZ | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2393135049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225XP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 2251P0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 111124700 | 05 | FL | MEDICAID |