Provider Demographics
NPI:1518679216
Name:PROFORM PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PROFORM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCAFIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-200-1280
Mailing Address - Street 1:1077 ROUTE 34 STE M
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2151
Mailing Address - Country:US
Mailing Address - Phone:732-970-7882
Mailing Address - Fax:732-970-7883
Practice Address - Street 1:1270 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2038
Practice Address - Country:US
Practice Address - Phone:732-200-1280
Practice Address - Fax:732-200-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy