Healthcare Provider Details

I. General information

NPI: 1215891973
Provider Name (Legal Business Name): FUNCTIONAL FORM PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 WESTBARD AVE STE 290
BETHESDA MD
20816-1520
US

IV. Provider business mailing address

16205 WHITEHAVEN RD
SILVER SPRING MD
20906-1129
US

V. Phone/Fax

Practice location:
  • Phone: 202-285-6292
  • Fax:
Mailing address:
  • Phone: 202-285-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANTOINE TOUMA
Title or Position: OWNER
Credential: MSPT
Phone: 202-285-6292