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

Form Functional Health LLC

Organization Physical Therapy Clinic/Center · NPI 1043999196

Form Functional Health LLC is a Physical Therapy Clinic/Center in Ridgewood, New Jersey. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

15 Godwin Ave Ste 1
Ridgewood, NJ 07450-3739
Phone: (973) 841-4800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Clinic/Center (primary) Taxonomy 261QP2000X

Record details

NPI number1043999196
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Raffaele Lagonigro — Owner · (973) 464-6356
NPI enumeratedJuly 17, 2023
Last updated in NPPESApril 12, 2024
Certification dateApril 12, 2024
Mailing address15 Godwin Ave Ste 1, Ridgewood, NJ 07450-3739

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