FORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC
NPI 1629903760
Physical Therapist in Bayside, NY
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
Specialties & Licenses
- 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.
Group Practice 1
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.