Form Physical Therapy, LLC
NPI 1700516820 · Physical Therapist · Westchester, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Form Physical Therapy, LLC is a Physical Therapist organization in Westchester, IL (NPI 1700516820).
Provider details
- NPI number
- 1700516820
- Entity type
- Organization
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Kevin Elavia, Owner(708) 497-4600
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
4 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
- 2022-06-13
- Last updated
- 2023-07-26
- Certified
- 2023-07-26
Frequently asked questions
- What is Form Physical Therapy, LLC's NPI number?
- Form Physical Therapy, LLC's National Provider Identifier (NPI) is 1700516820, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Form Physical Therapy, LLC?
- Form Physical Therapy, LLC is classified in the NPPES registry as Physical Therapist (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Form Physical Therapy, LLC located?
- Form Physical Therapy, LLC's practice location on file with NPPES is 10356 Roosevelt Rd, Westchester, IL 60154.
- What is Form Physical Therapy, LLC's phone number?
- The practice phone number listed in the NPPES registry for Form Physical Therapy, LLC is (708) 497-4600.
- Does Form Physical Therapy, LLC accept Medicare?
- Form Physical Therapy, LLC 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, LLC?
- The authorized official listed on Form Physical Therapy, LLC's NPPES record is Kevin Elavia, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Form Physical Therapy, LLC's NPI active?
- Yes — Form Physical Therapy, LLC's NPI (1700516820) is active in the NPPES registry as of the last update on 2023-07-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.