Healthcare Provider Details

I. General information

NPI: 1518679216
Provider Name (Legal Business Name): PROFORM PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 STATE ROUTE 35
MIDDLETOWN NJ
07748-2038
US

IV. Provider business mailing address

1077 ROUTE 34 STE M
ABERDEEN NJ
07747-2151
US

V. Phone/Fax

Practice location:
  • Phone: 732-200-1280
  • Fax: 732-200-9474
Mailing address:
  • Phone: 732-970-7882
  • Fax: 732-970-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN P. SCAFIDI
Title or Position: CO-OWNER
Credential: DPT
Phone: 732-200-1280