Provider Demographics
NPI:1003195702
Name:4X4 FITNESS, LLC
Entity Type:Organization
Organization Name:4X4 FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWENER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-597-2998
Mailing Address - Street 1:711 JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-8200
Mailing Address - Country:US
Mailing Address - Phone:860-597-2998
Mailing Address - Fax:
Practice Address - Street 1:711 JACOBS LN
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-8200
Practice Address - Country:US
Practice Address - Phone:860-597-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty