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General NPI Number Information
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NPI Number | 1003195702
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Entity Type | Organization
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Legal Business Name | 4X4 FITNESS, LLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 711 JACOBS LN
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City | NEWINGTON
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State | CT
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Zip | 06111-8200
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Country | US
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Telephone | 860-597-2998
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Fax |
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Provider Business Mailing Address
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Address Line | 711 JACOBS LN
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City | NEWINGTON
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State | CT
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Zip | 06111-8200
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Country | US
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Telephone | 860-597-2998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWENER
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Name | MR. MATTHEW STRANKO
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Credential | PT
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Telephone | 860-597-2998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | CT
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