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

Form Orthotics & Prosthetics, PLLC

Organization Prosthetic/Orthotic Supplier · NPI 1740113422

Form Orthotics & Prosthetics, PLLC is a Prosthetic/Orthotic Supplier in Rockford, Illinois. Registered with an NPI since 2026.

In the registry since
2026
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

4921 E State St Lowr Level
Rockford, IL 61108-2275
Phone: (402) 212-7878
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Prosthetic/Orthotic Supplier (primary) Taxonomy 335E00000X

Record details

NPI number1740113422
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Micah Alford — Founder · (402) 212-7878
NPI enumeratedJune 4, 2026
Last updated in NPPESJune 4, 2026
Certification dateJune 4, 2026
Mailing address4921 E State St Lowr Level, Rockford, IL 61108-2275

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