Provider Demographics
NPI:1952863524
Name:ENFIELD CLUB PROPERTIES, LLC
Entity Type:Organization
Organization Name:ENFIELD CLUB PROPERTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:413-563-7780
Mailing Address - Street 1:3 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-6006
Mailing Address - Country:US
Mailing Address - Phone:860-745-2408
Mailing Address - Fax:
Practice Address - Street 1:3 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-6006
Practice Address - Country:US
Practice Address - Phone:860-745-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty