Form Physical Therapy & Rehabilitation PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FORM PHYSICAL THERAPY & REHABILITATION PLLC

Practice address

7929 E 32ND St Ste 9
Yuma, AZ 85365-8505

Phone

(928) 920-0386

NPI assigned

Sep 22, 2026

Last updated

Sep 24, 2026By 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

Mrs. Kayla Renee Evans

Title

Owner

Phone

(928) 920-0386

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790208000000",
    "number": "1851203889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4219",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853662415",
            "telephone_number": "928-920-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7929 E 32ND ST STE 9",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853658505",
            "telephone_number": "928-920-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM PHYSICAL THERAPY & REHABILITATION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-920-0386",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Physical Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.