# FORM AND MOTION PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073893699
- **Authorized official:** INGRID PAILTHORP (OWNER AND PHYSICAL THERAPIST)
- **Authorized official phone:** (410) 703-6097

## Contact information

- **Practice address:** 304 B HARRY S. TRUMAN PARKWAY, ANNAPOLIS, MD 21401-7449
- **Practice address phone:** (410) 703-6097
- **Mailing address:** 304 B HARRY S. TRUMAN PARKWAY, ANNAPOLIS, MD 21401-7449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 23736 | MD | Yes |

## Other

- **Enumeration date:** 08/26/2011
- **Last updated:** 08/26/2011