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General NPI Number Information
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NPI Number | 1205961547
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Entity Type | Organization
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Legal Business Name | CHESHIRE FITNESS ZONE, LLC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 382 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-1379
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Country | US
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Telephone | 203-250-9663
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Fax | 203-699-9641
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Provider Business Mailing Address
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Address Line | 382 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-1379
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Country | US
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Telephone | 203-250-9663
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Fax | 203-699-9641
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG M. GOLDSTEIN
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Credential | PT
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Telephone | 203-250-9663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 005678
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 002758
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 003550
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 005678
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License Number State | CT
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