MEDICARE: FORWARD THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1205786704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORWARD THERAPY LLC

Provider Business Mailing Address
First Line	:	8125 NW 159TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-5803
Country	:	US
Telephone Number	:	305-797-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	8125 NW 159TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-5803
Country	:	US
Telephone Number	:	305-797-1771
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH-LANGUAGE PATHOLOGIST
Name	:	SYDNEY E KELLAS
Credential	:	MS CCC-SLP
Telephone Number	:	305-797-1771

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “FORWARD THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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