Healthcare Provider Details

I. General information

NPI: 1275454969
Provider Name (Legal Business Name): FORT MYERS THERAPY COLLECTIVE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 COLONIAL BLVD STE H64
FORT MYERS FL
33907-1010
US

IV. Provider business mailing address

1210 WALES DR
FORT MYERS FL
33901-7740
US

V. Phone/Fax

Practice location:
  • Phone: 941-564-9891
  • Fax:
Mailing address:
  • Phone: 407-718-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KINDRA TAYLOR
Title or Position: OWNER
Credential: LMHC
Phone: 407-718-6364