Form Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT008864 Issued in GA

Legal business name

FORM PHYSICAL THERAPY LLC

Practice address

1295 Hembree Rd Ste A201
Roswell, GA 30076

Phone

(678) 936-0821

NPI assigned

May 7, 2018

Last updated

May 12, 2018By 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

Blair Holliday, MPTNPI 1891001558

Title

Owner

Phone

(678) 936-0821

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

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.

• Blair A Holliday, MSPT

  • Physical Therapist
  • Atlanta, GA
  • NPI 1891001558
  Medicare reassignment Care Compare group NPD Authorized official
• Brian Matthew Holliday, DPT

  • Physical Therapist
  • Alpharetta, GA
  • NPI 1376943274
  Medicare reassignment Care Compare group NPD
• Natalie Jacobson, PT, DPT

  • Physical Therapist
  • Cumming, GA
  • NPI 1871105890
  Medicare reassignment Care Compare group NPD
• Brianna Reynolds, PT

  • Physical Therapist
  • Roswell, GA
  • NPI 1124990593
  Medicare reassignment Care Compare group NPD
• Meghan Alexandria Rud, PT, DPT

  • Physical Therapist
  • Marietta, GA
  • NPI 1871161778
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526083200000",
    "number": "1457840290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 DOVER AVE",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300093283",
            "telephone_number": "678-936-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1295 HEMBREE RD STE A201",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "678-936-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-12",
        "status": "A",
        "authorized_official_last_name": "HOLLIDAY",
        "authorized_official_first_name": "BLAIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-936-0821",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT008864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexcis Thomson Ford, M.D.
• Forensic Vocational Rehabilitation Consulting Group
• Mary Caroline Forester
• Mathieu Forgues, M.D
• Form Pelvic Health LLC
• Forma Medical Aesthetics
• Paria Foroughi Arani, RBT
• Alexis Danielle Fortson
• Tasia Fortune, PA
• Forward Strides Counseling LLC

• Physical Therapist in Roswell, GA
• Providers in Roswell, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2018; 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.