Provider Demographics
NPI:1699473686
Name:FORM & FUNCTION FYZIO PLLC
Entity type:Organization
Organization Name:FORM & FUNCTION FYZIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SAUERWALD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, AIB-VRC
Authorized Official - Phone:239-944-1597
Mailing Address - Street 1:1021 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-2298
Mailing Address - Country:US
Mailing Address - Phone:239-944-1597
Mailing Address - Fax:
Practice Address - Street 1:1021 11TH ST SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-2298
Practice Address - Country:US
Practice Address - Phone:239-944-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty