Provider Demographics
NPI:1205109832
Name:PHYSICAL FITNESS, LLC
Entity type:Organization
Organization Name:PHYSICAL FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL EXERCISE PHYSIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:203-488-5919
Mailing Address - Street 1:249 W MAIN ST
Mailing Address - Street 2:PHYSICAL FITNESS
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4048
Mailing Address - Country:US
Mailing Address - Phone:203-488-5919
Mailing Address - Fax:203-488-5946
Practice Address - Street 1:249 W MAIN ST
Practice Address - Street 2:PHYSICAL FITNESS
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4048
Practice Address - Country:US
Practice Address - Phone:203-488-5919
Practice Address - Fax:203-488-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty