FORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC
NPI 1629903760
Physical Therapist in Bayside, NY

Active since June 17, 2026
21426 41ST AVE STE 110, BAYSIDE, NY 11361(718) 279-9800 Get Directions Write a Review

NPPES record last updated: June 17, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Form Physical Therapy Lifestyle Wellness Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC (NPI 1629903760) is a healthcare organization registered as a physical therapist in Bayside, New York and active in the NPI registry since June 2026. The organization lists Dan Thomas, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1629903760
Entity TypeOrganization
Primary Taxonomy225100000X
Legal Business NameFORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC
Location Address21426 41ST AVE STE 110Bayside, NY 11361-2149
Mailing Address21426 41st Ave Ste 110Bayside, NY 11361-2149 · (718) 279-9800
Organization SubpartNo
Authorized OfficialDan ThomasPractice Administrator · (833) 442-2053
Enumeration DateJune 17, 2026
NPPES CertifiedJune 17, 2026
NPI 1629903760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
21426 41ST AVE STE 110, Bayside, NY 11361

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 Lifestyle Wellness PLLC's NPI number?

The NPI number for Form Physical Therapy Lifestyle Wellness PLLC is 1629903760. It was assigned to this organization in the NPPES registry on June 17, 2026.

Where is Form Physical Therapy Lifestyle Wellness PLLC located?

Form Physical Therapy Lifestyle Wellness PLLC is located at 21426 41st Ave Ste 110, Bayside, NY 11361. The listed phone number is (718) 279-9800.

What is Form Physical Therapy Lifestyle Wellness PLLC's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

When was this NPI record last updated?

The NPPES record for Form Physical Therapy Lifestyle Wellness PLLC was last updated on June 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 49 days 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.