Provider Demographics
NPI:1891789608
Name:THE PERFECT WORKOUT
Entity Type:Organization
Organization Name:THE PERFECT WORKOUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ST THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:860-409-9125
Mailing Address - Street 1:31 ENSIGN DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3773
Mailing Address - Country:US
Mailing Address - Phone:860-409-9125
Mailing Address - Fax:860-674-8031
Practice Address - Street 1:31 ENSIGN DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3773
Practice Address - Country:US
Practice Address - Phone:860-409-9125
Practice Address - Fax:860-674-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
CT261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100016182Medicare UPIN