Provider Demographics
NPI:1548611031
Name:LIFETIME FITNESS SOLUTIONS LLC
Entity Type:Organization
Organization Name:LIFETIME FITNESS SOLUTIONS LLC
Other - Org Name:GOLDEN YEARS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-964-0028
Mailing Address - Street 1:87 MICHAEL RD
Mailing Address - Street 2:APT A
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2432
Mailing Address - Country:US
Mailing Address - Phone:860-964-0028
Mailing Address - Fax:
Practice Address - Street 1:88 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3230
Practice Address - Country:US
Practice Address - Phone:860-964-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-25
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty