| Name: | FORM & FUNCTION PHYSICAL THERAPY AND SPORTS MEDICINE, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Dec 2013 (11 years ago) |
| Identification Number: | 000869919 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 250 SCRABBLETOWN ROAD, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | PROVIDES PHYSICAL THERAPY SERVICES |
NAICS
621340 Offices of Physical, Occupational and Speech Therapists, and AudiologistsThis industry comprises establishments of independent health practitioners primarily engaged in one of the following: (1) providing physical therapy services to patients who have impairments, functional limitations, disabilities, or changes in physical functions and health status resulting from injury, disease or other causes, or who require prevention, wellness or fitness services; (2) planning and administering educational, recreational, and social activities designed to help patients or individuals with disabilities regain physical or mental functioning or adapt to their disabilities; and (3) diagnosing and treating speech, language, or hearing problems. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629486550 | 2014-07-23 | 2018-01-31 | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 028523016, US | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 028523016, US | |||||||||||||||||
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| Phone | +1 617-326-3008 |
Authorized person
| Name | GUERRINO BONI |
| Role | OWNER |
| Phone | 4014658244 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | PT01838 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GUERRINO BONI | Agent | 22 INKBERRY TRAIL, NARRAGANSETT, RI, 02882, USA |
| Number | Name | File Date |
|---|---|---|
| 202445155770 | Annual Report | 2024-02-01 |
| 202343215530 | Annual Report | 2023-12-04 |
| 202343203500 | Statement of Change of Registered/Resident Agent | 2023-12-04 |
| 202215903930 | Annual Report | 2022-04-27 |
| 202105473950 | Annual Report | 2021-11-29 |
| 202077886190 | Annual Report | 2020-11-30 |
| 201927818820 | Annual Report | 2019-11-21 |
| 201881980300 | Annual Report | 2018-11-30 |
| 201754277830 | Annual Report | 2017-11-30 |
| 201628235340 | Annual Report | 2016-11-29 |
Date of last update: 18 Oct 2024
Sources: Rhode Island Department of State
