# PROEX PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831879311
- **Authorized official:** KATHLEEN BRUSH (MANAGER OF CREDENTIALING)
- **Authorized official phone:** (631) 359-5805

## Contact information

- **Practice address:** 19 NEEDHAM ST STE 201, NEWTON, MA 02461-1622
- **Practice address phone:** (617) 303-0455
- **Practice address fax:** (617) 303-0450
- **Mailing address:** 576 BROADHOLLOW RD, MELVILLE, NY 11747-5002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 07/20/2023
- **Last updated:** 10/29/2024