Form Physical Therapy Llc in Roswell, GA - Medicare Physical Therapist Provider

Form Physical Therapy Llc is a medicare enrolled "Physical Therapist" provider in Roswell, Georgia. Their current practice location is 1295 Hembree Rd Ste A201, Roswell, Georgia. You can reach out to their office (for appointments etc.) via phone at (678) 936-0821.

Form Physical Therapy Llc is licensed to practice in Georgia (license number PT008864) and it also participates in the medicare program. Form Physical Therapy Llc is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1457840290.

Contact Information

	Form Physical Therapy Llc
	1295 Hembree Rd Ste A201, Roswell, GA 30076
	(678) 936-0821
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Form Physical Therapy Llc
Type	Facility
Speciality	Physical Therapist
Location	1295 Hembree Rd Ste A201, Roswell, Georgia
Accepts Medicare Assignments	Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs.

NPI Data:

NPI Number: 1457840290
Provider Enumeration Date: 05/07/2018
Last Update Date: 05/12/2018

Medicare PECOS Information:

PECOS PAC ID: 0446595573
Enrollment ID: O20181218003432

Medical Identifiers

Medical identifiers for Form Physical Therapy Llc such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1457840290	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	PT008864 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Form Physical Therapy Llc acts as a billing entity for following providers:

Provider Name	Blair Alexis Holliday
Provider Type	Practitioner - Physical Therapist In Private Practice
Provider Identifiers	NPI Number: 1891001558 PECOS PAC ID: 5193910628 Enrollment ID: I20101110000828

Provider Name	Brian Matthew Holliday
Provider Type	Practitioner - Physical Therapist In Private Practice
Provider Identifiers	NPI Number: 1376943274 PECOS PAC ID: 5799007977 Enrollment ID: I20141124002105

Provider Name	Meghan Alexandria Rud
Provider Type	Practitioner - Physical Therapist In Private Practice
Provider Identifiers	NPI Number: 1871161778 PECOS PAC ID: 9335511195 Enrollment ID: I20230206000323

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Form Physical Therapy Llc is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Form Physical Therapy Llc 4005 Dover Ave, Alpharetta, GA 30009-3283 Ph: (678) 936-0821	Form Physical Therapy Llc 1295 Hembree Rd Ste A201, Roswell, GA 30076 Ph: (678) 936-0821

Reviews and Comments

Physical Therapist in Roswell, GA

Mr. Nicholas B Swanner, MPT, GCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1000 Applewood Dr, Brookdale Therapy, Roswell, GA 30076 Phone: 404-971-8544 Fax: 414-918-6046
Mrs. Dawnella Grace Harrison, PHYSICAL THERAPIST Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3455 Johnson Ferry Rd Ne, Roswell, GA 30075 Phone: 770-998-6636
Kathryn Hodges Rose, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 11490 Alpharetta Hwy Ste 200, Roswell, GA 30076 Phone: 770-740-8592 Fax: 770-752-9478
Jasmine Elizabeth Ramans, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 10800 Alpharetta Hwy Ste 176, Roswell, GA 30076 Phone: 678-681-1060 Fax: 678-681-9049
Suzanne Sacks, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24 E Crossville Rd, Roswell, GA 30075 Phone: 678-822-0721
Ellen Pye, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1570 Holcomb Bridge Rd Ste 205, Roswell, GA 30076 Phone: 678-619-0003 Fax: 678-619-0004
Jann Allyn Jennelle, PT, LMT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 102 Russell Rd, Roswell, GA 30075 Phone: 678-431-7096 Fax: 678-348-7334

Form Physical Therapy Llc - Medicare Physical Therapist in Roswell, GA