MEDICARE: ENVISION REHAB AND PERFORMANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1225688567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION REHAB AND PERFORMANCE LLC

Provider Business Mailing Address
First Line	:	436 MOHAWK DR
Second Line	:
City	:	EAST BURKE
State	:	VT
Zip	:	05832-4408
Country	:	US
Telephone Number	:	802-323-2903
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 MEADOW ST
Second Line	:
City	:	LITTLETON
State	:	NH
Zip	:	03561-3603
Country	:	US
Telephone Number	:	802-323-2903
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LANCE BERRY
Credential	:
Telephone Number	:	802-323-2903

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	05/29/2025

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