Form & Function Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

20814 Issued in MD

Legal business name

FORM & FUNCTION PHYSICAL THERAPY LLC

Practice address

5924 Marlboro Pike
District Heights, MD 20747-1142

Phone

(202) 316-3658

Fax

(301) 967-1215

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Anderson, MPTNPI 1225248693

Title

President

Phone

(301) 967-1215

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

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

• Kevin A Anderson, MPT

  • Orthopedic Physical Therapist
  • District Heights, MD
  • NPI 1225248693

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306454400000",
    "number": "1508080219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5924 MARLBORO PIKE",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207471142",
            "fax_number": "301-967-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5924 MARLBORO PIKE",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207471142",
            "telephone_number": "202-316-3658",
            "fax_number": "301-967-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM & FUNCTION PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2011-05-27",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-967-1215",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "20814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in District Heights, MD
• Providers in District Heights, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; 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.