Forma Rehabilitation, Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FORMA REHABILITATION, INC

Practice address

24100 Drake Rd
Ste B
Farmington Hills, MI 48335

Phone

(248) 471-9414

Fax

(248) 442-5012

NPI assigned

May 27, 2016

Organization subpart

No

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

Authorized official

Name

Bryan Genrich

Title

Authorized Official

Phone

(248) 862-7760

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1215385406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28104 ORCHARD LAKE RD",
            "address_2": "SUITE 110",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343701",
            "telephone_number": "248-539-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24100 DRAKE RD",
            "address_2": "STE B",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "48335",
            "telephone_number": "248-471-9414",
            "fax_number": "248-442-5012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMA REHABILITATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-27",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "GENRICH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "248-862-7760"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shavon Foreman
• Zamouria Foreman
• David Steven Forester, DDS
• Jacinda Forester
• Morgan Laurin Forgette, DO
• Saul Z Forman, M.D.
• Aaliyah Forney-Leslie
• Doris Forney
• Aniya Forrer-Grimes
• Shalonda Forrest

• Physical Therapy Clinic/Center in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.