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General NPI Number Information
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NPI Number | 1740345818
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Entity Type | Organization
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Legal Business Name | PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 168 DENSLOW RD
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-3188
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Country | US
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Telephone | 413-526-9969
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Fax | 413-526-9960
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 630-296-2222
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Fax |
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Authorized Official
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Title or Position | VP CHIEF COMPLIANCE OFFICER
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Name | WADE A MEYER
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Credential |
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Telephone | 630-296-2222
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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