Form Physical Therapy, a Professional Corporation
NPI 1174770630 · Physical Therapy Clinic/Center · San Francisco, CA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Form Physical Therapy, a Professional Corporation is a Physical Therapy Clinic/Center organization in San Francisco, CA (NPI 1174770630).
Provider details
- NPI number
- 1174770630
- Entity type
- Organization
- Primary specialty
- Physical Therapy Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Stacee Brown, Owner/President(415) 297-4113
- License
- 29589 (CA)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 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
Other names (DBA / former)
- Doing business as
- Form Physical Therapy
Registry dates
- Enumerated
- 2008-08-26
- Last updated
- 2012-09-06
Frequently asked questions
- What is Form Physical Therapy, a Professional Corporation's NPI number?
- Form Physical Therapy, a Professional Corporation's National Provider Identifier (NPI) is 1174770630, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Form Physical Therapy, a Professional Corporation?
- Form Physical Therapy, a Professional Corporation is classified in the NPPES registry as Physical Therapy Clinic/Center (Ambulatory Health Care Facilities).
- Where is Form Physical Therapy, a Professional Corporation located?
- Form Physical Therapy, a Professional Corporation's practice location on file with NPPES is 2358 Pine Street, San Francisco, CA 94115.
- What is Form Physical Therapy, a Professional Corporation's phone number?
- The practice phone number listed in the NPPES registry for Form Physical Therapy, a Professional Corporation is (415) 297-4113.
- Does Form Physical Therapy, a Professional Corporation accept Medicare?
- Form Physical Therapy, a Professional Corporation is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Form Physical Therapy, a Professional Corporation?
- The authorized official listed on Form Physical Therapy, a Professional Corporation's NPPES record is Stacee Brown, Owner/President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Form Physical Therapy, a Professional Corporation's NPI active?
- Yes — Form Physical Therapy, a Professional Corporation's NPI (1174770630) is active in the NPPES registry as of the last update on 2012-09-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.