FORM PHYSICAL THERAPY
NPI 1174770630
Clinic/Center - Physical Therapy in San Francisco, CA
About Form Physical Therapy NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FORM PHYSICAL THERAPY (NPI 1174770630) is a healthcare organization registered as a physical therapy in San Francisco, California and active in the NPI registry since August 2008. The organization lists Stacee Lee Brown, Owner/president, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Form Physical Therapy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Form Physical Therapy, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Form Physical Therapy, A Professional Corporation's NPI number?
The NPI number for Form Physical Therapy, A Professional Corporation is 1174770630. It was assigned to this organization in the NPPES registry on August 26, 2008. The provider is doing business as Form Physical Therapy.
Where is Form Physical Therapy, A Professional Corporation located?
Form Physical Therapy, A Professional Corporation is located at 2358 Pine Street, San Francisco, CA 94115. The listed phone number is (415) 297-4113.
What is Form Physical Therapy, A Professional Corporation's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Physical Therapy, with taxonomy code 261QP2000X.
Is Form Physical Therapy, A Professional Corporation enrolled in Medicare?
Yes. Form Physical Therapy, A Professional Corporation is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Form Physical Therapy, A Professional Corporation?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Therapist in Private Practice) reassigns their Medicare billing to Form Physical Therapy, A Professional Corporation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Form Physical Therapy, A Professional Corporation was last updated on September 6, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Form Physical Therapy · NPI 1174770630
Physical Therapy organization in San Francisco, California. Organization record, active in the CMS NPPES registry since August 26, 2008.
## Identity
- **NPI:** 1174770630 (Entity type: Organization)
- **Enumerated:** August 26, 2008
- **Primary specialty:** Clinic/Center - Physical Therapy · taxonomy 261QP2000X
- **Legal business name:** Form Physical Therapy, A Professional Corporation
- **Organization subpart:** No
- **Authorized official:** Stacee Brown, OWNER/PRESIDENT
## Practice location
- **Address:** 2358 PINE STREET, San Francisco, CA 94115
- **Phone:** (415) 297-4113 · **Fax:** (415) 684-7694
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Physical Therapist in Private Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 6, 2012
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Source: [NPI Profile](https://npiprofile.com/npi/1174770630) · Data from the CMS NPPES public registry.