OrganizationActive
Form Orthotics & Prosthetics, PLLC
NPI 1740113422 · Prosthetic/Orthotic Supplier · Rockford, IL
Provider details
- NPI number
- 1740113422
- Entity type
- Organization
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Micah Alford, Founder(402) 212-7878
Specialties & taxonomies
Suppliers
Practice location
4921 E State St Lowr Level
Rockford, IL 61108-2275
Phone: (402) 212-7878
Approximate (ZIP-level) locationGet directions
Mailing address
4921 E State St Lowr Level
Rockford, IL 61108-2275
Registry dates
- Enumerated
- 2026-06-04
- Last updated
- 2026-06-04
- Certified
- 2026-06-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.