NPIMap

Organization Active NPI

Proform Physical Therapy LLC

  • Physical Therapist
  • Aberdeen, NJ
National Provider Identifier
1073958351
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFORM PHYSICAL THERAPY LLC
Practice address
1077 Route 34 Ste M
Aberdeen, NJ 07747-2151
Phone
(732) 970-7882
Fax
(732) 970-7883
NPI assigned
May 1, 2013
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Leonard Jesus Somarriba, PTNPI 1629224647
Title
Doctor of Physical Therapy
Phone
(561) 676-3565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X NJ
Physical Therapist 225100000X NJ Primary

Addresses

Primary practice location

1077 Route 34 Ste M
Aberdeen, NJ 07747-2151

Mailing address

1077 Route 34 Ste M
Aberdeen, NJ 07747-2151
Phone (732) 970-7882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131011001239 NJ DME Supplier - Independently-Practicing Physical Therapist 9436383114 Practice locations: Aberdeen, NJ
O20131022001577 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9436383114 Receives reassigned benefits from 35 practitioners
Practice locations: Old Bridge, NJ; Middletown, NJ; Edison, NJ; Aberdeen, NJ; East Brunswick, NJ

National Provider Directory

National Provider Directory
Tax ID family
Proform Physical Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1077 State Route 34
Ste M
Matawan, NJ 07747
Phone (732) 970-7882

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1073958351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1077 ROUTE 34 STE M",
            "city": "ABERDEEN",
            "state": "NJ",
            "postal_code": "077472151",
            "telephone_number": "732-970-7882",
            "fax_number": "732-970-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 ROUTE 34 STE M",
            "city": "ABERDEEN",
            "state": "NJ",
            "postal_code": "077472151",
            "telephone_number": "732-970-7882",
            "fax_number": "732-970-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFORM PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "SOMARRIBA",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "JESUS",
        "authorized_official_title_or_position": "DOCTOR OF PHYSICAL THERAPY",
        "authorized_official_telephone_number": "561-676-3565",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.