FORM & FUNCTION PHYSICAL THERAPY AND SPORTS MEDICINE LLC
NPI 1629486550
Specialist in North Kingstown, RI
About Form & Function Physical Therapy And Sports Medicine Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FORM & FUNCTION PHYSICAL THERAPY AND SPORTS MEDICINE LLC (NPI 1629486550) is a healthcare organization registered as a specialist in North Kingstown, Rhode Island and active in the NPI registry since July 2014. The organization lists Guerrino Boni, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 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 & Function Physical Therapy And Sports Medicine Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Form & Function Physical Therapy And Sports Medicine LLC, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (2)
Middletown, RI 02842
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 & Function Physical Therapy And Sports Medicine LLC's NPI number?
The NPI number for Form & Function Physical Therapy And Sports Medicine LLC is 1629486550. It was assigned to this organization in the NPPES registry on July 23, 2014.
Where is Form & Function Physical Therapy And Sports Medicine LLC located?
Form & Function Physical Therapy And Sports Medicine LLC is located at 250 Scrabbletown Rd, North Kingstown, RI 02852. The listed phone number is (617) 326-3008.
What is Form & Function Physical Therapy And Sports Medicine LLC's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Form & Function Physical Therapy And Sports Medicine LLC enrolled in Medicare?
Yes. Form & Function Physical Therapy And Sports Medicine LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Form & Function Physical Therapy And Sports Medicine LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Form & Function Physical Therapy And Sports Medicine LLC. 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 & Function Physical Therapy And Sports Medicine LLC was last updated on January 31, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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 & Function Physical Therapy And Sports Medicine Llc · NPI 1629486550
Specialist organization in North Kingstown, Rhode Island. Organization record, active in the CMS NPPES registry since July 23, 2014.
## Identity
- **NPI:** 1629486550 (Entity type: Organization)
- **Enumerated:** July 23, 2014
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Guerrino Boni, OWNER
## Practice location
- **Address:** 250 SCRABBLETOWN RD, North Kingstown, RI 02852-3016
- **Phone:** (617) 326-3008
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Physical Therapist in Private Practice) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 31, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1629486550) · Data from the CMS NPPES public registry.