Form & Focus- Rehab & Wellness, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FORM & FOCUS- REHAB & WELLNESS, PLLC

Practice address

22576 Visnaw St
Saint Clair Shores, MI 48081-2641

Phone

(586) 443-6176

NPI assigned

Jul 3, 2023

Organization subpart

No

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

Authorized official

Name

Katherine AndaryNPI 1972968600

Title

Physical Therapist

Phone

(586) 443-6176

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 2

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

• Katherine Andary

  • Physical Therapist
  • Grosse Pointe Farms, MI
  • NPI 1972968600
  Medicare reassignment Care Compare group NPD Authorized official
• Samantha Ortiz

  • Occupational Therapist
  • Warren, MI
  • NPI 1821598673
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1417634296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22576 VISNAW ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22576 VISNAW ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812641",
            "telephone_number": "586-443-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM & FOCUS- REHAB & WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "ANDARY",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "586-443-6176"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Fockler-Labute
• Gail Terese Foley
• Kumudinie C Fonseka, MD
• Gwendolyn Forbes, CPHT
• Brittany Forestell, MS CCC SLP
• Form Physical Therapy, LLC
• James Albert Fortune, MD
• Lynne E. Foster, R.N.
• Mark Fouad-Meshriky
• Krista Marie Fournier

• Physical Therapy Clinic/Center in Saint Clair Shores, MI
• Providers in Saint Clair Shores, 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 Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.