Provider Demographics
NPI:1891415469
Name:FORM FIRST PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FORM FIRST PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:413-668-4758
Mailing Address - Street 1:4 PRATT HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-1536
Mailing Address - Country:US
Mailing Address - Phone:413-668-4758
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1284
Practice Address - Country:US
Practice Address - Phone:413-668-4758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty