Provider Demographics
NPI:1174061683
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:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-939-9319
Mailing Address - Street 1:83 EAST AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4902
Mailing Address - Country:US
Mailing Address - Phone:203-939-9319
Mailing Address - Fax:
Practice Address - Street 1:83 EAST AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-939-9319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 225700000X
CTT58152225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty