Organization
FITNESS PANTHEON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES O'BRIEN PT (CO-OWNER, PHYSICAL THERAPIST)
(860) 967-9341
Entity
Organization
Contact information
Practice address
221 WATER STREET, TORRINGTON, CT 06790
(860) 967-9341
Mailing address
221 WATER STREET, TORRINGTON, CT 06790
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
008560
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190328
—
CT
01
—
076503001
MEDICARE NUMBER
—
Enumeration date
03/04/2014
Last updated
03/04/2014
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