Healthcare Provider Details

I. General information

NPI: 1891789608
Provider Name (Legal Business Name): THE PERFECT WORKOUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ENSIGN DR
AVON CT
06001-3773
US

IV. Provider business mailing address

31 ENSIGN DR
AVON CT
06001-3773
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-9125
  • Fax: 860-674-8031
Mailing address:
  • Phone: 860-409-9125
  • Fax: 860-674-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: MR. MATTHEW FRANCIS ST THOMAS
Title or Position: OWNER/MEMBER
Credential: ATC
Phone: 860-409-9125