Form Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FORM PHYSICAL THERAPY, LLC

Practice address

10356 Roosevelt Rd
Westchester, IL 60154

Phone

(708) 497-4600

Fax

(708) 497-4601

NPI assigned

Jun 13, 2022

Organization subpart

No

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

Authorized official

Name

Kevin Elavia, DPTNPI 1831445170

Title

Owner

Phone

(708) 497-4600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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.

• Kevin Elavia, DPT

  • Physical Therapist
  • Westchester, IL
  • NPI 1831445170
  Medicare reassignment Care Compare group NPD Authorized official
• Karli Anne Korsch, P.T. D.P.T

  • Physical Therapist
  • Maywood, IL
  • NPI 1952657090
  Medicare reassignment Care Compare group NPD
• Stefanie M Lawton, PT

  • Physical Therapist
  • Westchester, IL
  • NPI 1164700274
  Medicare reassignment Care Compare group NPD
• Lindsey Ann Waite, DPT

  • Physical Therapist
  • Chicago, IL
  • NPI 1740902089
  Medicare reassignment Care Compare group NPD
• Russell Deghi

  • Physical Therapist
  • Chicago, IL
  • NPI 1609415470
  Medicare reassignment NPD

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1700516820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10356 ROOSEVELT RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "60154",
            "telephone_number": "708-497-4600",
            "fax_number": "708-497-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10356 ROOSEVELT RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "60154",
            "telephone_number": "708-497-4600",
            "fax_number": "708-497-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-13",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "ELAVIA",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-497-4600",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Fernandez
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• Linda Anne Flajnik-Peter, R. N.
• Kenyata M Fletcher, PHD, LPC, CRADC
• Floss Dental Studios
• Fox Rehabilitation Services Il LLC
• Patrick Francis, DO
• Jeana Marie Frazier, LPC, NCC
• Susan Gabel, MA, LCPC
• Galdor Medical PC

• Physical Therapist in Westchester, IL
• Providers in Westchester, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.