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General NPI Number Information
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NPI Number | 1215891973
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FORM PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 5400 WESTBARD AVE STE 290
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City | BETHESDA
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State | MD
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Zip | 20816-1520
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Country | US
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Telephone | 202-285-6292
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Fax |
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Provider Business Mailing Address
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Address Line | 16205 WHITEHAVEN RD
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City | SILVER SPRING
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State | MD
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Zip | 20906-1129
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Country | US
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Telephone | 202-285-6292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTOINE TOUMA
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Credential | MSPT
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Telephone | 202-285-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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