| Organization Name: | FORM AND FUNCTION PHYSICAL THERAPY PC. |
| NPI Number: | 1316332505 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMIR MILAD HANNA (PHYSICAL THERAPIST) |
| Mailing Address: | 55 Jericho Tpke Suite 202 Jericho |
| State: | NY US |
| Postal Code: | 117531013 |
| Phone Number: | 5165320734 |
| Fax Number: | 5164659656 |
| NPI Enumeration Date: | 04/03/2015 |
| NPI Last Update Date: | 04/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0179761 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |