# FORM & FUNCTION PHYSICAL THERAPY LLC

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

## Provider details

- **NPI number:** 1508080219
- **Authorized official:** MR. KEVIN ANDERSON MPT (PRESIDENT)
- **Authorized official phone:** (301) 967-1215

## Contact information

- **Practice address:** 5924 MARLBORO PIKE, DISTRICT HEIGHTS, MD 20747-1142
- **Practice address phone:** (202) 316-3658
- **Practice address fax:** (301) 967-1215
- **Mailing address:** 5924 MARLBORO PIKE, DISTRICT HEIGHTS, MD 20747-1142
- **Mailing address fax:** (301) 967-1215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 20814 | MD | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 05/27/2011