Healthcare Provider Details

I. General information

NPI: 1992182695
Provider Name (Legal Business Name): PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SPRINGFIELD RD STE 6
WESTFIELD MA
01085-1884
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-1388
  • Fax: 413-568-1389
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number790
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number790
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number790
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number790
License Number StateMA

VIII. Authorized Official

Name: WADE A MEYER
Title or Position: VP CHIEF COMPLIANCE OFFICER
Credential:
Phone: 630-296-2222