Form Medical, PLLC

Primary specialty

Neuromuscular Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081N0008X

License

DR.0058123 Issued in CO

Legal business name

FORM MEDICAL, PLLC

Practice address

1525 Raleigh St Ste 220
Denver, CO 80204-1374

Phone

(720) 370-9559

NPI assigned

Aug 25, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jessica Kelner, DO

Title

Physician/Manager

Phone

(720) 370-9559

Specialties & licenses 1

Addresses

Other names 1

• FORM Medical Doing business as

Locations

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831616390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 RALEIGH ST STE 220",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802041374",
            "telephone_number": "720-370-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 RALEIGH ST STE 220",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802041374",
            "telephone_number": "720-370-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KELNER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "PHYSICIAN/MANAGER",
        "authorized_official_telephone_number": "720-370-9559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081N0008X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": "CO",
            "license": "DR.0058123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORM Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Cecile Forest, PA-C
• Hannah Elizabeth Forester, RN
• Stacy Forget, M.A, LPC
• Frances Forgione, LCSW
• Tyson Reed Forkner, M.S. MFTC
• Barr H Forman
• Noah Forman, PT, DPT
• Rachel Formantes, MSW, LCSW
• Formosa Physical Therapy LLC
• John A Forney, DDS

• Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician in Denver, CO
• Providers in Denver, CO by specialty
• Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.