Provider Demographics
NPI:1316562994
Name:BARBELL PHYSICAL THERAPY AND PERFORMANCE, LLC
Entity Type:Organization
Organization Name:BARBELL PHYSICAL THERAPY AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNIEUWENHUYZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-817-4612
Mailing Address - Street 1:10 AVALON DR UNIT 3232
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8576
Mailing Address - Country:US
Mailing Address - Phone:860-817-4612
Mailing Address - Fax:
Practice Address - Street 1:87 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1705
Practice Address - Country:US
Practice Address - Phone:860-817-4612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy