Organization
SUMMIT FITNESS & REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM LEE GRANGER MSPT (SOLE MEMBER)
(203) 546-8648
Entity
Organization
Contact information
Practice address
195 FEDERAL RD, SUITE 6, BROOKFIELD, CT 06804-2556
(203) 546-8648
Mailing address
195 FEDERAL RD, SUITE 6, BROOKFIELD, CT 06804-2556
(203) 546-8648
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
008174
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020621971
TRICARE NORTH ID
CT
Enumeration date
07/29/2008
Last updated
06/19/2013
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