Healthcare Provider Details

I. General information

NPI: 1164723391
Provider Name (Legal Business Name): PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BRIDGE STREET
BELCHERTOWN MA
01007-8909
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440
US

V. Phone/Fax

Practice location:
  • Phone: 413-323-1020
  • Fax: 413-323-5020
Mailing address:
  • Phone: 630-296-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BIRON
Title or Position: CEO
Credential: PT
Phone: 413-529-6669