Healthcare Provider Details

I. General information

NPI: 1205803558
Provider Name (Legal Business Name): FITNESS FORUM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIBERTY ST SUITE 1300
BROCKTON MA
02301-5521
US

IV. Provider business mailing address

322 E CENTER ST
WEST BRIDGEWATER MA
02379-1824
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-0144
  • Fax: 508-580-0449
Mailing address:
  • Phone: 508-559-0993
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES SMITH
Title or Position: CEO
Credential:
Phone: 315-477-0888