Provider Demographics
NPI:1194098137
Name:MASSAGE AND FITNESS, LLC
Entity type:Organization
Organization Name:MASSAGE AND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,CPT,AT
Authorized Official - Phone:203-984-5980
Mailing Address - Street 1:5 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-4105
Mailing Address - Country:US
Mailing Address - Phone:203-984-5980
Mailing Address - Fax:203-286-8779
Practice Address - Street 1:83 EAST AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-984-5980
Practice Address - Fax:203-286-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTT58152225400000X
2255A2300X
CT002967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty