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

Form Physical Therapy, a Professional Corporation

Organization Physical Therapy Clinic/Center · NPI 1174770630

Form Physical Therapy, a Professional Corporation is a Physical Therapy Clinic/Center in San Francisco, California. Licensed in California. Registered with an NPI since 2008.

Licensed in
CA
In the registry since
2008

Practice location Address checks out

2358 Pine St
San Francisco, CA 94115
Phone: (415) 297-4113
Fax: (415) 684-7694
Show map & directions

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

Specialties & licences

Physical Therapy Clinic/Center (primary) Taxonomy 261QP2000X · Licence 29589 (CA)

Record details

NPI number1174770630
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stacee Brown — Owner/President · (415) 297-4113
Other names Form Physical Therapy
NPI enumeratedAugust 26, 2008
Last updated in NPPESSeptember 6, 2012
Mailing address68 Dominican Drive, San Rafael, CA 94901

Other providers in San Francisco