Proform Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROFORM PHYSICAL THERAPY LLC

Practice address

510 Route 18
East Brunswick, NJ 08816-3092

Phone

(732) 970-7882

Fax

(732) 970-7883

NPI assigned

Dec 19, 2018

Organization subpart

No

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

Authorized official

Name

Leonard Jesus Somarriba, PT

Title

Owner

Phone

(732) 770-7882

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545177600000",
    "number": "1306318092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 HIGHWAY 34 STE 24-25",
            "city": "ABERDEEN",
            "state": "NJ",
            "postal_code": "077471903",
            "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": "510 ROUTE 18",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163092",
            "telephone_number": "732-970-7882",
            "fax_number": "732-970-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFORM PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2018-12-19",
        "status": "A",
        "authorized_official_last_name": "SOMARRIBA",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "JESUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-770-7882",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.