Provider Demographics
NPI:1639870819
Name:FORM AND FUNCTION PELVIC HEALTH, INC.
Entity Type:Organization
Organization Name:FORM AND FUNCTION PELVIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEENY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:412-636-6004
Mailing Address - Street 1:1039 PEERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2223
Mailing Address - Country:US
Mailing Address - Phone:412-636-6004
Mailing Address - Fax:412-643-2462
Practice Address - Street 1:302 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1404
Practice Address - Country:US
Practice Address - Phone:412-636-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy