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General NPI Number Information
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NPI Number | 1275999419
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Entity Type | Organization
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Legal Business Name | PROFORM PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 08/14/2021
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Provider Practice Location Address
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Address Line | 175 ELM ST UNIT C
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City | SALISBURY
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State | MA
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Zip | 01952-1827
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Country | US
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Telephone | 978-255-4238
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Fax | 978-473-7543
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Provider Business Mailing Address
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Address Line | 175 ELM ST UNIT C
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City | SALISBURY
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State | MA
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Zip | 01952-1827
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Country | US
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Telephone | 978-255-4238
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Fax | 978-473-7543
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Authorized Official
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Title or Position | OWNER
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Name | CHAD BURNHAM
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Credential | DPT
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Telephone | 978-255-4238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20821
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License Number State | MA
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