NPIMap

Organization Active NPI

Proform Physical Therapy LLC

  • Physical Therapist
  • Edison, NJ
National Provider Identifier
1861047854
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFORM PHYSICAL THERAPY LLC
Practice address
1921 Route 27
Edison, NJ 08817-3250
Phone
(732) 970-7882
Fax
(732) 970-7883
NPI assigned
Aug 6, 2019
Last updated
Aug 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

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

Authorized official

Name
Leonard Jesus Somarriba, PTNPI 1629224647
Title
Owner
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

1921 Route 27
Edison, NJ 08817-3250

Mailing address

1212 Highway 34 Ste 24-25
Matawan, NJ 07747-1903
Phone (732) 970-7882

National Provider Directory

National Provider Directory

Locations

1921 Route 27
Edison, NJ 08817
Phone (732) 290-4511

2124 State Route 35
Holmdel, NJ 07733
Phone (732) 671-7277

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

1212 State Route 34
Ste 2425
Matawan, NJ 07747
Phone (732) 970-7882

2665 Highway 516
Old Bridge, NJ 08857
Phone (732) 952-8826

2665 Highway 516
Unit 1314
Old Bridge, NJ 08857
Phone (732) 952-8826

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565049600000",
    "number": "1861047854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 HIGHWAY 34 STE 24-25",
            "city": "MATAWAN",
            "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": "1921 ROUTE 27",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088173250",
            "telephone_number": "732-970-7882",
            "fax_number": "732-970-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFORM PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-06",
        "last_updated": "2019-08-06",
        "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": "561-676-3565",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.