| Organization Name: | FORM & FUNCTION PHYSICAL THERAPY LLC |
| NPI Number: | 1508080219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN ANDERSON (PRESIDENT) |
| Mailing Address: | 5924 Marlboro Pike District Heights |
| State: | MD US |
| Postal Code: | 207471142 |
| Phone Number: | 2023163658 |
| Fax Number: | 3019671215 |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 05/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 20814 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| 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 |