Form and Function Physical Therapy PC.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0179761 Issued in NY

Legal business name

FORM AND FUNCTION PHYSICAL THERAPY PC.

Practice address

55 Jericho Tpke
Suite 202
Jericho, NY 11753-1013

Phone

(516) 532-0734

Fax

(516) 465-9656

NPI assigned

Apr 3, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Amir Milad Hanna, PT

Title

Physical Therapist

Phone

(516) 532-0734

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sherine Mina, OT

  • Occupational Therapist
  • Smithtown, NY
  • NPI 1063860237
  NPD (past)

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1316332505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 JERICHO TPKE",
            "address_2": "SUITE 202",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117531013",
            "telephone_number": "516-532-0734",
            "fax_number": "516-465-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 JERICHO TPKE",
            "address_2": "SUITE 202",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117531013",
            "telephone_number": "516-532-0734",
            "fax_number": "516-465-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM AND FUNCTION PHYSICAL THERAPY PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "AMIR",
        "authorized_official_middle_name": "MILAD",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "516-532-0734",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0179761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Sue Falgoust
• Faye Grand, Otr L CHT
• Gabriella Irene Ficarra
• Eileen Finke
• Regina Marie Finta, AUD
• Ronishia Foster, MHC-LP
• Bruce Lee Friedman, DC
• Clyde Friedman, M.S.W., L.C.S.W.
• Amanda Frobosilo
• Danielle Rose Gambino

• Physical Therapist in Jericho, NY
• Providers in Jericho, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.