Organization Name: | 4X4 FITNESS, LLC |
NPI Number: | 1003195702 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW STRANKO (PRESIDENT/OWENER) |
Mailing Address: | 711 Jacobs Ln Newington |
State: | CT US |
Postal Code: | 061118200 |
Phone Number: | 8605972998 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2011 |
NPI Last Update Date: | 08/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |