Healthcare Provider Details

I. General information

NPI: 1649009879
Provider Name (Legal Business Name): FOCUS BRAIN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 W STATE ROAD 84 STE 208
DAVIE FL
33324-4235
US

IV. Provider business mailing address

10650 W STATE ROAD 84 STE 208
DAVIE FL
33324-4235
US

V. Phone/Fax

Practice location:
  • Phone: 754-778-8685
  • Fax: 954-208-9854
Mailing address:
  • Phone: 754-778-8685
  • Fax: 954-208-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA KAY HUSEBOE
Title or Position: CEO
Credential: CH
Phone: 954-410-2999