Form Functional Health LLC
NPI #1043999196 in Ridgewood, New Jersey
Provider Information
- NPI Number
- 1043999196
- Entity Type
- Organization
- Organization Name
- Form Functional Health LLC
- Primary Specialty
- Clinic/Center - Physical Therapy
- Enumeration Date
- Jul 17, 2023
- Last Updated
- Apr 12, 2024
Practice Location
- Address
- 15 GODWIN AVE STE 1
- City
- Ridgewood
- State
- New Jersey
- ZIP Code
- 07450-3739
- Phone
- (973) 841-4800
Authorized Official
- Name
- RAFFAELE LAGONIGRO, PT, DPT
- Title
- OWNER
- Phone
- (973) 464-6356
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Physical Therapy — Physical Therapy |
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