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General NPI Number Information
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NPI Number | 1649436700
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Entity Type | Organization
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Legal Business Name | SUMMIT FITNESS & REHABILITATION, LLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 195 FEDERAL RD SUITE 6
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City | BROOKFIELD
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State | CT
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Zip | 06804-2556
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Country | US
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Telephone | 203-546-8648
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Fax |
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Provider Business Mailing Address
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Address Line | 195 FEDERAL RD SUITE 6
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City | BROOKFIELD
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State | CT
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Zip | 06804-2556
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Country | US
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Telephone | 203-546-8648
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. ADAM LEE GRANGER
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Credential | MSPT
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Telephone | 203-546-8648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 008174
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License Number State | CT
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