Healthcare Provider Details

I. General information

NPI: 1457058802
Provider Name (Legal Business Name): CLINICAL FITNESS 101 CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 GONDOLIER WAY
LAKE WORTH FL
33462-3622
US

IV. Provider business mailing address

3344 GONDOLIER WAY
LAKE WORTH FL
33462-3622
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-0745
  • Fax:
Mailing address:
  • Phone: 561-247-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE L MATTA
Title or Position: FOUNDER/CEO
Credential: DPT
Phone: 561-247-0745