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 1700516820

Form Physical Therapy, LLC is a Physical Therapist in Westchester, Illinois. Registered with an NPI since 2022.

In the registry since
2022
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

10356 Roosevelt Rd
Westchester, IL 60154
Phone: (708) 497-4600
Fax: (708) 497-4601
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1700516820
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kevin Elavia — Owner · (708) 497-4600
NPI enumeratedJune 13, 2022
Last updated in NPPESJuly 26, 2023
Certification dateJuly 26, 2023
Mailing address10356 Roosevelt Rd, Westchester, IL 60154

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