# FUNCTIONAL FORM PHYSICAL THERAPY, LLC

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

## Provider details

- **NPI number:** 1215891973
- **Authorized official:** ANTOINE TOUMA MSPT (OWNER)
- **Authorized official phone:** (202) 285-6292

## Contact information

- **Practice address:** 5400 WESTBARD AVE STE 290, BETHESDA, MD 20816-1520
- **Practice address phone:** (202) 285-6292
- **Mailing address:** 16205 WHITEHAVEN RD, SILVER SPRING, MD 20906-1129
- **Mailing address phone:** (202) 285-6292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/16/2025
- **Last updated:** 12/16/2025