NPIMap

Organization Active NPI

Proex Physical Therapy, LLC

  • Occupational Therapist
  • Newton, MA
National Provider Identifier
1831879311
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
PROEX PHYSICAL THERAPY, LLC
Practice address
19 Needham St Ste 201
Newton, MA 02461-1622
Phone
(617) 303-0455
Fax
(617) 303-0450
NPI assigned
Jul 20, 2023
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Kathleen Brush
Title
Manager of Credentialing
Phone
(631) 359-5805

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU Primary

Addresses

Primary practice location

19 Needham St Ste 201
Newton, MA 02461-1622

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240630000064 MA DME Supplier - Independently-Practicing Occupational TherapistDME Supplier - Independently-Practicing Physical Therapist 0345212395 Practice locations: Newton, MA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Proex Physical Therapy LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

19 Needham St
Ste 201
Newton, MA 02461
Phone (617) 213-1350

NPI Registry JSON

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

{
    "created_epoch": "1689811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1831879311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 NEEDHAM ST STE 201",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024611622",
            "telephone_number": "617-303-0455",
            "fax_number": "617-303-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROEX PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-20",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "BRUSH",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "MANAGER OF CREDENTIALING",
        "authorized_official_telephone_number": "631-359-5805"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.