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General NPI Number Information
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NPI Number | 1053254540
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Entity Type | Organization
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Legal Business Name | FORM PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 39 COLONIAL WOODS DR
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1614
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Country | US
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Telephone | 732-221-6703
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Fax |
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Provider Business Mailing Address
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Address Line | 39 COLONIAL WOODS DR
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1614
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Country | US
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Telephone | 732-221-6703
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MICHAEL THOMAS FELLER
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Credential | DPT
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Telephone | 732-221-6703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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