Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Form & Fitness

Organization Physical Therapist · NPI 1063612067

Form & Fitness is a Physical Therapist in Mequon, Wisconsin. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

11053 N Port Washington Rd
Mequon, WI 53092-5032
Phone: (262) 241-3449
Fax: (262) 241-5229
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1063612067
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ben Quist — President · (262) 241-3449
NPI enumeratedJuly 19, 2007
Last updated in NPPESJuly 19, 2007
Mailing address11053 N Port Washington Rd, Mequon, WI 53092-5032

Other providers in Mequon