Form Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FORM PHYSICAL THERAPY LLC

Practice address

39 Colonial Woods Dr
West Orange, NJ 07052-1614

Phone

(732) 221-6703

NPI assigned

Apr 10, 2026

Last updated

Apr 10, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Thomas Feller, DPTNPI 1952641466

Title

Owner/Physical Therapist

Phone

(732) 221-6703

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael T Feller, DPT

  • Physical Therapist
  • New York, NY
  • NPI 1952641466
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1775779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1053254540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 COLONIAL WOODS DR",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521614",
            "telephone_number": "732-221-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 COLONIAL WOODS DR",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521614",
            "telephone_number": "732-221-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-10",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A",
        "authorized_official_last_name": "FELLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "732-221-6703",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Flynn, RD
• Nikita Fonarev
• Foot and Ankle Health Center of Bloomfield LLC
• Foot Care 2 You Inc
• Forge Medical Group, LLC (Forge Health)
• Mark Howard Forman, MD
• Forman&Hertz,M.D.L.L.C.
• Lori Susan Fortunato, LSW
• Carla Renee Foster, PSY.D.
• Erin Fowler

• Physical Therapy Clinic/Center in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.