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General NPI Number Information
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NPI Number | 1194098137
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Entity Type | Organization
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Legal Business Name | MASSAGE AND FITNESS, LLC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 83 EAST AVE SUITE 313
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City | NORWALK
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State | CT
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Zip | 06851-4902
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Country | US
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Telephone | 203-984-5980
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Fax | 203-286-8779
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Provider Business Mailing Address
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Address Line | 5 OAK ST
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City | NORWALK
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State | CT
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Zip | 06854-4105
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Country | US
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Telephone | 203-984-5980
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Fax | 203-286-8779
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Authorized Official
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Title or Position | OWNER
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Name | MR. PATRICK BOYER
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Credential | LMT,CPT,AT
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Telephone | 203-984-5980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | T58152
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 002967
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License Number State | CT
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