Provider Demographics
NPI:1447445523
Name:PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Entity type:Organization
Organization Name:PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-781-1054
Practice Address - Fax:413-439-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X, 2251H1200X, 225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA972730OtherNETWORK HEALTH
MA000000035257OtherBOSTON MEDICAL CENTER
MA103355100OtherDEPT OF LABOR
MA043527OtherCT CARE
MA64-04290OtherUNITED
MAY61264OtherBLUE SHIEL PT
MA690675OtherTUFTS
MA28117OtherHNE
MA9715668Medicaid
MAOG0011OtherBLUE SHIELD OT
MA=========OtherGIC
MA=========OtherCIGNA
MA9715668Medicaid
MAOG0011OtherBLUE SHIELD OT
MAPT0191Medicare PIN