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

Form Physical Therapy LLC

Organization Physical Therapist · NPI 1457840290

Form Physical Therapy LLC is a Physical Therapist in Roswell, Georgia. Licensed in Georgia. Registered with an NPI since 2018.

Licensed in
GA
In the registry since
2018
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

1295 Hembree Rd Ste A201
Roswell, GA 30076
Phone: (678) 936-0821
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT008864 (GA)

Record details

NPI number1457840290
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Blair Holliday — Owner · (678) 936-0821
NPI enumeratedMay 7, 2018
Last updated in NPPESMay 12, 2018
Mailing address4005 Dover Ave, Alpharetta, GA 30009-3283

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