Provider Demographics
NPI:1225688567
Name:ENVISION REHAB AND PERFORMANCE LLC
Entity type:Organization
Organization Name:ENVISION REHAB AND PERFORMANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-323-2903
Mailing Address - Street 1:436 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:EAST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05832-4408
Mailing Address - Country:US
Mailing Address - Phone:802-323-2903
Mailing Address - Fax:
Practice Address - Street 1:566 MEADOW ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3603
Practice Address - Country:US
Practice Address - Phone:802-323-2903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic