Form & Fitness
NPI 1063612067 · Physical Therapist · Mequon, WI
Form & Fitness is a Physical Therapist organization in Mequon, WI (NPI 1063612067).
Provider details
- NPI number
- 1063612067
- Entity type
- Organization
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Ben Quist, President(262) 241-3449
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2007-07-19
- Last updated
- 2007-07-19
Frequently asked questions
- What is Form & Fitness's NPI number?
- Form & Fitness's National Provider Identifier (NPI) is 1063612067, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Form & Fitness?
- Form & Fitness is classified in the NPPES registry as Physical Therapist (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Form & Fitness located?
- Form & Fitness's practice location on file with NPPES is 11053 N Port Washington Rd, Mequon, WI 53092-5032.
- What is Form & Fitness's phone number?
- The practice phone number listed in the NPPES registry for Form & Fitness is (262) 241-3449.
- Who is the authorized official for Form & Fitness?
- The authorized official listed on Form & Fitness's NPPES record is Ben Quist, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Form & Fitness's NPI active?
- Yes — Form & Fitness's NPI (1063612067) is active in the NPPES registry as of the last update on 2007-07-19.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.