| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ENRI FORT | 1497385520 | 2024-11-10 |
Enri Fort is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1497385520. Registration indicates Enri Fort is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Developmental Therapist (Developmental Therapist, ) (Developmental Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers) (Speech, Language and Hearing Service Providers, Speech-Language Pathologist) (Speech-Language Pathologist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Speech-Language Pathologist, Speech, Language and Hearing Service Providers)
| Entity Type | Individual |
| Provider Name | Enri Fort MS,CCC-SLP |
| Other Provider Name | Enri Yamashita Fort |
| Practice Office Address | 1992 LEWIS TURNER BLVD SUITE 1067 #255 FORT WALTON BEE, FL US |
| Practice Office Telephone | 8508303314 |
| Practice Office Fax | 8509040355 |
| Mailing Address | 106 BLACK BEAR CIR NICEVILLE, FL 325781202 US |
| Business Telephone | 8508303314 |
| Business Fax | 8509040355 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 10043 Idlewild Rd | Matthews, NC 281052013 | 7045454220 |
| 907 Mar Walt Dr Ste 2013 | Fort Walton Beach, FL 325476756 | 8503663694 / 7734928765 |
| secure mail [] | [email protected] | |
| secure email [] | [email protected] | Direct |
| secure email [] | [email protected] | Health Information Exchange (HIE) |
| emal [] | [email protected] | Direct |
| website and messaging [] | thespeechpod.com | Other information and messaging |
| Code | Practice | License No State |
|---|---|---|
| 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Developmental Therapist Developmental Therapist Developmental Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 18378
FL |
| 235Z00000X PRIMARY | Speech, Language and Hearing Service Providers Speech-Language Pathologist Speech-Language Pathologist Speech/Occupational/Physical Therapy/Chiropractor Speech-Language Pathologist Speech, Language and Hearing Service Providers | SA18378
FL |
| 117725200 | MEDICAID | FL | |
| 12030298 | OTHER | MD | ASHA CCC |
| SA18378 | OTHER | FL | DOH |
| 118480700 | MEDICAID | FL | |
| 117493600 | MEDICAID | FL | |
| 118599100 | MEDICAID | FL |