Function and Form Physical Therapy LLC
NPI 1124646294ActiveOrganization· Physical Therapist· Santa Teresa, NM
Physical Therapist in Santa Teresa, New Mexico, registered in NPPES in July 2020. The authorized official on file is Derrick Delgado, PTA, Member.
Overview
| NPI | 1124646294 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 6, 2020 |
| Last updated in NPPES | Mar 28, 2021 |
| Certified by provider | Mar 28, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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