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

Form Medical, PLLC

Organization Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1831616390

Form Medical, PLLC is a Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician in Denver, Colorado. Licensed in Colorado. Registered with an NPI since 2017.

Licensed in
CO
In the registry since
2017
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1525 Raleigh St Ste 220
Denver, CO 80204-1374
Phone: (720) 370-9559
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician (primary) Taxonomy 2081N0008X · Licence DR.0058123 (CO)

Record details

NPI number1831616390
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jessica Kelner — Physician/Manager · (720) 370-9559
Other names Form Medical
NPI enumeratedAugust 25, 2017
Last updated in NPPESJuly 21, 2022
Mailing address1525 Raleigh St Ste 220, Denver, CO 80204-1374

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