Organization
FITNESS FORUM SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES SMITH (CEO)
(315) 477-0888
Entity
Organization
Contact information
Practice address
110 LIBERTY ST, SUITE 1300, BROCKTON, MA 02301-5521
(508) 580-0144
(508) 580-0449
Mailing address
322 E CENTER ST, WEST BRIDGEWATER, MA 02379-1824
(508) 559-0993
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
613818
TUFTS
MA
01
—
623323
HARVARD PILGRIM HEALTHCARE
MA
05
—
9786384
—
MA
Enumeration date
03/07/2006
Last updated
05/27/2008
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